Attachment 7- Experience Questionnaire.docx
DOCX document 33 KB Posted
- Solicitation number
- 1240LU26Q0021
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire template used by the USDA Forest Service for evaluating vendor qualifications in response to RFQ #1240LU26Q0021 for the replacement of the foundation at a historic barn at Star Meadows in the Flathead National Forest, Montana.
The questionnaire requires vendors to provide comprehensive information about their experience and capability to perform the work, including: contractor identification and contact information; years of experience in the relevant field as both prime and subcontractors; detailed project history from the past three years with completion dates and owner references; current contractual commitments; disclosure of any prior work failures, performance bond completions, or contract terminations for default; and detailed information on available employees and equipment for the project. Vendors must provide estimated timelines for four specific work items: mobilization, excavation and backfill for buildings, precast concrete utility building installation, and MEP wellhead replacement with utility equipment and water system connection. Additionally, vendors must identify key personnel who will be directly involved in the project and provide a narrative response describing their experience with similar work in comparable geographical and environmental conditions, including remote locations, foundation work in damp climates, and historical building restoration. The form requires certification by the vendor's official attesting to the accuracy and completeness of all provided information.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
VENDOR RESPONSE TO FACTOR 1 – EXPERIENCE (a) and (b) RFQ #1240LU26Q0021 Replace Foundation of Historic Barn at Star Meadows, Flathead NF, Montana Page 1
VENDOR RESPONSE TO FACTOR 1 - EXPERIENCE RFQ #1240LU26Q0021
Replace Foundation at Historic Barn at Star Meadows, Flathead NF, Montana
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: Factor 1 – Technical Experience (a): Complete Blocks 1 through 10, and use the space on Page 3 of this Questionnaire Form for any additional information you would like to add to support your responses to Blocks 1 through 10.
1. Contractor Name, Address, Telephone # & UEI #
2. Submitted to (Office Name and Address) mary.harding@usda.gov
3. Business [ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual
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 had as a (a) prime contractor ______ and/or (b) sub-contractor ______?
6. List below the projects your business has completed within the last three (3) years:
| Total $ Value |
| Description or Title of Project |
| Date Completed |
| Name, & Telephone No. of |
Owner/Person to Contact for Project Information
7. List below your firm’s contractual commitments running concurrently with the work contemplated by this solicitation, if any:
| Contract, Task Order or Purchase Order Number |
| Dollar Amt. of Award |
| Name, Address, and Telephone No. of Business Owner or Government Agency Involved |
| Subcontractor or Prime Contractor |
| Percent Completed |
| Date 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. Has contracted work ever been terminated for default? [ ] Yes [ ] No 8d. If “Yes” to either item 8a.,8b., or 8c., specify location(s) and reason(s) why:
EXPERIENCE QUESTIONNAIRE CONTINUED – PAGE 2
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 to be used for this Purchase Order:______________________________________________________
| Work Item No. | |
| Work Description | |
| Estimated |
No. of Days to Complete Estimated Hrs of Onsite Work Per Day Starting Time and End Time
| 0001 |
| Mobilization |
| 0002 |
| Excavation and Backfill for Buildings |
| 0003 |
| Precast Concrete Utility Building Installation |
| 0004 |
| MEP Wellhead Replacement, Utility Equipment, and Water System Connection |
d. Estimate progress rates for work items of this project:
10. List below the experience of the principal individuals of your business who will directly be involved in this Purchase Order.
| Individual’s Name |
| Present Position |
| Years of Experience |
| Magnitude and Type of Work |
11. Provide response to Factor 1 – Technical Experience (b): Provide a narrative specifying details of the experience the firm has, either as a Prime Contractor (General Contractor, or GC) or as a Subcontractor, for work similar in nature and scope in geographical conditions similar to this requirement (for example, remote location; foundation work in damp climate; historical building or structure, etc.)
Attach sheets if extra space is needed to fully address this factor (b), and specify that the extra sheet(s) is for Factor 1 – Technical Experience (b).
EXPERIENCE QUESTIONNAIRE CONTINUED – PAGE 3
NOTE: PLEASE PROVIDE BELOW ANY ADDITIONAL INFORMATION TO SUPPORT BLOCKS 1 THROUGH 10 OF THIS FORM 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 OF OFFEROR AND TITLE
| b. SIGNATURE (Sign in ink) |
| 13. DATE |
File details come from the government source that posted it. Updated .