Attachment 7 -Experience Questionnaire.pdf
PDF 490 KB Posted
- Attached to
- Lake Alva Campground Improvements
- Solicitation number
- 1240LU26Q0055
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor capability and qualifications for federal contract opportunities.
The questionnaire collects comprehensive information about a contractor's background and capacity to perform work. Section 1 requires basic contractor identification including name, email, address, and phone number. Section 2 requests submission location (Forest Service PPS, 1019 N 5th St, Custer, SD 57730) and Section 3 requires specification of business type (Company, Co-Partnership, Corporation, Individual, or Non-profit Organization). Sections 4 and 5 gather experience data, including years in the relevant line of work and years of experience as a prime contractor and/or sub-contractor. Section 6 requires detailed documentation of similar projects completed or currently underway within the last three years, including contract amounts, federal contract numbers if applicable, project types, completion dates or ongoing status, and contact information for project references. Sections 7a-7c address past performance issues, requiring disclosure of any failure to complete awarded work or use of performance bonds, with explanations of locations and reasons if applicable. Section 8 documents organizational capacity, including minimum and maximum employee availability, payroll status, and equipment specifications. Section 9 requires listing of principal individuals with their positions, years of experience, and work magnitude/type. Section 10 provides space for remarks and clarifications. Section 11 contains a certification statement requiring the authorized official to attest that all information is complete and correct. Section 12 requires the certifying official's name, title, and signature in ink, along with the date of submission.
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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 .