Attachment 6 - Experience Questionnaire.pdf

PDF 210 KB Posted

Attached to
Raco Work Center Janitorial Federal contract opportunity
Solicitation number
12444525Q0031
Issued by
Department of Agriculture Forest Service

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The document is an Experience Questionnaire for a USDA Forest Service contract opportunity for janitorial services at the Raco Work Center. The form requires potential contractors to provide detailed information about their business, including years of experience, past project history, current contractual commitments, organizational capacity, and key personnel qualifications. Specific sections request information on minimum and maximum number of employees, progress rates, equipment inventory, inspection and quality control procedures, and a safety plan. Contractors must also disclose any previous contract performance issues and certify the accuracy of their submitted information. The questionnaire is designed to help the Forest Service evaluate a contractor's capability to successfully perform the janitorial services contract.

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Attachment 5 - Wage Determination.pdf PDF
Attachment 4 - Drawings Pictures Plans Maps.pdf PDF
Attachment 2 - Statement Of Work (SOW).pdf PDF
Attachment 3 - QASP.pdf PDF
12444525Q0031.pdf PDF
Attachment 1 - Schedule Of Items.pdf PDF

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Attachment H – Experience Questionnaire

USDA – Forest Service

EXPERIENCE QUESTIONNAIRE

(Ref. FSH 6309.31 and 41 USC 1)

INSTRUCTIONS: See Box 13, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.

1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.

UEI (Formerly DUNS #) _____________________ E-Mail #_____________________

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 in contracting 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/DESCRIPTION

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

COMPLETED

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. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why:

Previous edition is obsolete (OVER) FS-6300-27 (3/00)

9. Organization and work that will be available for this project.

a. (1) Minimum number of employees: _____ and Maximum number of employees: _____

b. Are employees regularly on your payroll: Yes No

c. Estimate rate of progress below (such as 2.0 acres/man/day)

(1) Minimum progress rate: ________________________________ and (2) maximum progress rate: ________________________

10. List below the experience of the principal individuals of your business:

INDIVIDUAL’S NAME

PRESENT

POSITION

YEARS

OF EXP.

MAGNITUDE AND TYPE OF WORK

11. List all the equipment (including vehicles) you plan to use on this contract. Provide a detailed description of the Equipment including your maintenance plan.

12. Contractor Inspection/Quality Control, Safety Plan, and Proposed Schedule. Describe Contractor Self Inspection Procedures which you will use to insure quality for this contract. Please include information on the purchase and use of any bio-based products & materials to be used on this project, a brief safety plan, and your planned schedule of work.

13. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):

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 name 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

UEI Formerly DUNS:
EMail:
2 SUBMITTED TO office Name and Address:
Company: Off
Corporation: Off
Nonprofit Organization: Off
Copartnership: Off
Individual: Off
4 How many years do you or your firm have in the line of work contemplated by this solicitation:
undefined:
undefined_2:
5 How many years experience in contracting have you or your business had as a a prime contractor andor b subcontractor:
6 List below the projects your business has completed within the last three years:
CONTRACT AMOUNTRow1:
TYPE OF PROJECTDESCRIPTIONRow1:
DATE COMPLETEDRow1:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow1:
CONTRACT AMOUNTRow2:
TYPE OF PROJECTDESCRIPTIONRow2:
DATE COMPLETEDRow2:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow2:
CONTRACT AMOUNTRow3:
TYPE OF PROJECTDESCRIPTIONRow3:
DATE COMPLETEDRow3:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow3:
CONTRACT AMOUNTRow4:
TYPE OF PROJECTDESCRIPTIONRow4:
DATE COMPLETEDRow4:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow4:
CONTRACT AMOUNTRow5:
TYPE OF PROJECTDESCRIPTIONRow5:
DATE COMPLETEDRow5:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow5:
CONTRACT AMOUNTRow6:
TYPE OF PROJECTDESCRIPTIONRow6:
DATE COMPLETEDRow6:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow6:
CONTRACT AMOUNTRow7:
TYPE OF PROJECTDESCRIPTIONRow7:
DATE COMPLETEDRow7:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow7:
CONTRACT AMOUNTRow8:
TYPE OF PROJECTDESCRIPTIONRow8:
DATE COMPLETEDRow8:
NAME ADDRESS AND TELEPHONE NO OF OWNERPERSON TO CONTACT FOR PROJECT INFORMATIONRow8:
CONTRACT NUMBERRow1:
DOLLAR AMT OF AWARDRow1:
NAME ADDRESS AND TELEPHONE NO OF BUSINESSGOVERNMENT AGENCY INVOLVEDRow1:
AWARDED UnitsRow1:
PERCENT COMPLETEDRow1:
DATE CONTRACT COMPLETEDRow1:
CONTRACT NUMBERRow2:
DOLLAR AMT OF AWARDRow2:
NAME ADDRESS AND TELEPHONE NO OF BUSINESSGOVERNMENT AGENCY INVOLVEDRow2:
AWARDED UnitsRow2:
PERCENT COMPLETEDRow2:
DATE CONTRACT COMPLETEDRow2:
CONTRACT NUMBERRow3:
DOLLAR AMT OF AWARDRow3:
NAME ADDRESS AND TELEPHONE NO OF BUSINESSGOVERNMENT AGENCY INVOLVEDRow3:
AWARDED UnitsRow3:
PERCENT COMPLETEDRow3:
DATE CONTRACT COMPLETEDRow3:
CONTRACT NUMBERRow4:
DOLLAR AMT OF AWARDRow4:
NAME ADDRESS AND TELEPHONE NO OF BUSINESSGOVERNMENT AGENCY INVOLVEDRow4:
AWARDED UnitsRow4:
PERCENT COMPLETEDRow4:
DATE CONTRACT COMPLETEDRow4:
CONTRACT NUMBERRow5:
DOLLAR AMT OF AWARDRow5:
NAME ADDRESS AND TELEPHONE NO OF BUSINESSGOVERNMENT AGENCY INVOLVEDRow5:
AWARDED UnitsRow5:
PERCENT COMPLETEDRow5:
DATE CONTRACT COMPLETEDRow5:
CONTRACT NUMBERRow6:
DOLLAR AMT OF AWARDRow6:
NAME ADDRESS AND TELEPHONE NO OF BUSINESSGOVERNMENT AGENCY INVOLVEDRow6:
AWARDED UnitsRow6:
PERCENT COMPLETEDRow6:
DATE CONTRACT COMPLETEDRow6:
undefined_3: Off
undefined_4: Off
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 If Yes to either item 8a or 8b specify locations and reasons whyRow1:
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 If Yes to either item 8a or 8b specify locations and reasons whyRow2:
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 If Yes to either item 8a or 8b specify locations and reasons whyRow3:
a 1 Minimum number of employees:
and Maximum number of employees:
Estimate rate of progress below such as 20 acresmanday: Off
1 Minimum progress rate:
and 2 maximum progress rate:
10 List below the experience of the principal individuals of your business:
INDIVIDUALS NAMERow1:
PRESENT POSITIONRow1:
YEARS OF EXPRow1:
MAGNITUDE AND TYPE OF WORKRow1:
INDIVIDUALS NAMERow2:
PRESENT POSITIONRow2:
YEARS OF EXPRow2:
MAGNITUDE AND TYPE OF WORKRow2:
INDIVIDUALS NAMERow3:
PRESENT POSITIONRow3:
YEARS OF EXPRow3:
MAGNITUDE AND TYPE OF WORKRow3:
INDIVIDUALS NAMERow4:
PRESENT POSITIONRow4:
YEARS OF EXPRow4:
MAGNITUDE AND TYPE OF WORKRow4:
INDIVIDUALS NAMERow5:
PRESENT POSITIONRow5:
YEARS OF EXPRow5:
MAGNITUDE AND TYPE OF WORKRow5:
INDIVIDUALS NAMERow6:
PRESENT POSITIONRow6:
YEARS OF EXPRow6:
MAGNITUDE AND TYPE OF WORKRow6:
11 List all the equipment including vehicles you plan to use on this contract Provide a detailed description of the Equipment including your maintenance plan:
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 name as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project:
12a CERTIFYING OFFICIALS NAME AND TITLE:
b SIGNATURE Sign in ink:
13 DATE:

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