Attachment B- EXPERIENCE QUESTIONNAIRE.docx

DOCX document 19 KB Posted

Attached to
Hoosier National Forest Blue Creek Stream Clearing
Solicitation number
12444524Q0069
Issued by

About this file

This document is an Experience Questionnaire that appears to be part of a federal contract opportunity. It requests information about the contractor's business, including years of experience, similar past projects, current contract commitments, capability to complete the work, and experience of key personnel. The related federal contract opportunity is for stream clearing work in the Hoosier National Forest in Indiana, where tornado damage has caused several blockages along a 1-mile reach of Blue Creek that require partial or full removal. The contract opportunity is being solicited by the Department of Agriculture Forest Service.

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Other files

File Type Posted
Attachment A- PWS_QASP_Blue Creek_Debris Removal.docx DOCX document
Attachment F- Map 1.pdf PDF
Attachment E- Wage Determinations.txt TXT text file
Attachment H- Map 3.pdf PDF
Attachment D- NRE_Commercial Services RFQ_12444524Q0069.docx DOCX document
Attachment G- Map 2.jpg JPG image
Attachment J- SF1449-12444524Q0069.pdf PDF
Attachment C- Schedule of Items.docx DOCX document
Attachment I- Evaluation Criteria.docx DOCX document

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EXPERIENCE QUESTIONNAIRE

1. Contractor’s Name, Address & Telephone #.

2. Type of Business

___Company ___Co-Partner ___Corporation ___Individual ___Non-profit Organization

3. How many years experience do you have related to this line of work? _______ years
4. How many years experience as a prime contractor? ________years

Subcontractor? _______

5. List all the similar projects your business has completed in the last three (3) years.

CONTRACT AMOUNT
TYPE OF CONTRACT WORK
DATE COMPLETED
Contact Name, Address and Tele. #

6. List all of your firms’ current contract commitments

CONTRACT NUMBER
AWARD AMOUNT
Contact Name, Address & Tele. #
Percent Completed
Date Contract Completed
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 above, specify reason(s) and location(s) why.

8. Organization structure that will be available for this project:

a. Minimum No. of employees: _____and Maximum No. of employees:_____
b. Are employees regularly on your payroll?___yes___no

c. Specify equipment to be used for this contract:

d. Estimate rate of progress (exp. 100 feet, 1/8 mile a day, etc…):

Minimum progress rate:____________ Maximum progress rate:____________

9. List the experience of the principal individuals of your business

NAME
PRESENT POSITION
YRS EXP.
TYPE OF WORK

10. GPS and Shapefile experience:

11. Work plan: Describe plan how to accomplish task.

TIN#__________________ Duns#_______________ CERTIFICATION: I certify that all of the statements made by me are complete and correct to be 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.

______________________________________________________________________________
SignaturePrint or Typed NameTitleDate

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