Attachment 6 Experience Questionnaire.docx
DOCX document 24 KB Posted
- Solicitation number
- 1284LM26Q0030
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire template used by the USDA Forest Service to evaluate contractor qualifications and capability to perform contracted work. The form requires prospective contractors to provide comprehensive background information including company details, years of experience in the relevant field, and prime versus subcontractor experience. Contractors must list completed projects from the past three years with contract amounts, project types, completion dates, and owner contact information for reference verification. The questionnaire also requests disclosure of all concurrent contractual commitments, including contract numbers, dollar amounts, completion percentages, and completion dates, to assess capacity and availability.
The form includes mandatory questions regarding project completion history, performance bond usage, and on-site project inspection, with space for explanation if applicable. Contractors must specify the minimum and maximum number of employees available for the project, confirm whether employees are regularly on payroll, and detail equipment that will be allocated to the contract. A critical section requires listing principal individuals who will directly manage the contract, including their position, years of experience, and work magnitude/type. The form concludes with a certification statement in which the certifying official attests under penalty of perjury that all information is complete and accurate, authorizing the Forest Service to contact named references to verify the contractor's capability to successfully complete the project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment 4 Summary Information Chart AMD 0001.xlsx | XLSX spreadsheet | |
| SF-30.pdf | ||
| Attachment 1 Solicitation Terms and Conditions AMD 0001.docx | DOCX document | |
| Attachment 2 Statement of Work.docx | DOCX document | |
| Attachment 5 Wage Determination.pdf | ||
| Attachment 1 Solicitation Terms and Conditions.docx | DOCX document | |
| Attachment 3 Area Maps.pdf | ||
| Attachment 4 Summary Information Chart.xlsx | XLSX spreadsheet |
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Text version
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.
1. Contractor Name, Address, and Telephone Number
2. Submitted to (Office Name and Address)
3. Business [ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual [ ] Non-profit Organization
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. How many years experience have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?
6. List below the projects your business has completed within the last three years:
| Contract Amount |
| Type of Project |
| Date Completed |
| Name, Address, and Telephone No. of Owner/Person to Contact for Project Information |
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
| Contract Number |
| Dollar Amt. of Award |
| Name, Address, and Telephone No. of Business/Government Agency Involved |
| Awarded (Units) |
| Percent Completed |
| Date Contract Complete |
8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No 8b. Has work ever been completed by performance bond? [ ] Yes [ ] No 8c. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:
EXPERIENCE QUESTIONNAIRE CONTINUED
9. Employees and equipment that will be available for this project:
a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____
b. Are employees regularly on your payroll: [ ] Yes [ ] No
c. Specify equipment available for this contract:______________________________________________________
10. List below the experience of the principal individuals of your business. (Who will directly be involved in this contract?)
| Individual’s Name |
| Present Position |
| Years of Experience |
| Magnitude and Type of Work |
11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):
NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT.
CERTIFICATION
I certify that all of the statements made by me are complete and correct to the best of my knowledge, and that any persons named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
12a. CERTIFYING OFFICIAL’S NAME AND TITLE
| b. SIGNATURE (Sign in ink) |
| 13. DATE |
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