Attachment 6 -Experience Questionnaire.pdf
PDF 490 KB Posted
- Attached to
- Buffalo Gap Campground water line repairs
- Solicitation number
- 1240LU26Q0071
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor qualifications for federal contract opportunities.
The form requests comprehensive information about a contractor's background and capability to perform Forest Service work. Contractors must provide their business name, contact information, business type (company, corporation, partnership, individual, or non-profit), and years of experience in the contemplated line of work. Section 5 requires documentation of prime contractor and subcontractor experience. Section 6 requires listing of projects completed within the last three years with similar work, including contract amounts, federal contract numbers if applicable, project types, completion dates, and reference contact information. Section 7 addresses contract performance history, specifically asking whether the contractor has ever failed to complete awarded work or required performance bond completion, with space to explain any affirmative responses. Section 8 requests information about available resources, including minimum and maximum employee counts, payroll status, and detailed specifications of equipment available for the contract. Section 9 requires listing principal individuals involved in the business with their positions, years of experience, and magnitude and type of work experience. Section 10 provides space for additional remarks or clarifications to any preceding questions. The form concludes with a certification statement (Section 11) wherein the certifying official attests under oath that all provided information is complete and accurate, with signature, printed name, title, and date required in Section 12.
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Text version
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 10, Remarks, if extra space is needed to answer any item below. Mark “x” in appropriate boxes.
1. Contractor Name, email Address, and phone number
2. Submitted to (Office Name & Address) 3. Business type 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 (or currently working) where we can confirm that your company has experience in similar work.
Contract Amount & Federal Contract # if applicable
Type of Project Ongoing or
Date Completed
Person to Contact for Project Information include email or phone #
7a. Have you ever failed to complete any work awarded to you? _____ Yes _____ No 7b. Has work ever been completed by performance bond? _____ Yes _____ No 7c. If “Yes” to either item 7a or 7b specify location(s) and reason(s) why:
Forest Service PPS 1019 N 5th St Custer, SD 57730
8. Organization and work that will be available for this project:
a. (1) Minimum number of employees:__________ and a (2) Maximum number of employees:__________
b. Are employees regularly on your payroll? _____ Yes _____ No
c. Specify equipment available for this contract
9. List below the experience of the principal individuals of your business:
Individual’s Name
And City of Residence Present Position Years of
Exp.
Magnitude and Type of Work
10. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):
11. 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
12b. Signature (Sign in Ink) 13. Date
File details come from the government source that posted it. Updated .