Attachment E Questionaire.pdf
PDF 117 KB Posted
- Solicitation number
- 12443926Q0013
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form required by the USDA Forest Service for contractors who have not sold to the agency within the past 18 months. The questionnaire collects comprehensive information about a contractor's business qualifications, experience, and financial responsibility to assess their capability to perform Forest Service contracts.
The form requires contractors to provide basic business information including company name, address, contact details, and business type (company, corporation, co-partner, non-profit, or individual). Contractors must document their years of experience in their line of work and specify experience as prime contractors versus subcontractors. The questionnaire requests detailed information about projects completed within the three years prior to solicitation issuance, including contract numbers, award amounts, contact references, percentage completion, and completion dates. Contractors must also list all current contract commitments with similar documentation. Section 7 requires disclosure of any past failures to complete awarded work or situations where performance bonds were used, with detailed explanations of locations and reasons. The form collects organizational information including minimum and maximum employee counts, payroll status, available equipment, and estimated rates of progress specific to the work. Contractors must provide names and experience details of principal individuals overseeing the project. Finally, the questionnaire requires credit and banking references with company names, addresses, points of contact, and telephone numbers to support responsibility determinations. All responses must be certified as complete and correct by an authorized company representative.
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Text version
Attachment 4
EXPERIENCE QUESTIONNAIRE
Instructions: If your business has not sold to the USDA Forest Service in the past 18 months complete questionnaire. See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
1. Contractors Name, Address & Telephone No. Email
2. Type of Business __Company __Co-Partner __Non-profit __Corporation __Individual
3. Howmany years experience do you have in this line of work____Yrs
4. How many years experience as a prime contractpr_____ subcontractor___
5. List the projects your business has completed in the last 3 years from the solicitation issuance date
CONTRACT
NUMBER
AWARD
AMOUNT
NAME ADDRESS & PHONE
NO. TO CONTACT FOR INFO.
PERCENT
COMPLETED
DATE CONTRACT
COMPLETED
6. List all of your firms current contract commitments
CONTRACT
NUMBER
AWARD
AMOUNT
NAME ADDRESS & PHONE NO. TO CONTACT
FOR INFO.
PERCENT
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
7. If "yes" to either item 7a or 7b specify location(s) and reason(s) why
8. Organization information available for this project:
a. Minimum # of employees: and Maximum # of employees:
b. Are employees regularly on your payroll: __yes __ no
c. Specify equipment available for this contract:
d. Estimate rate of progress (such as 2.0 acres per day):
1. Minimum progress rate: Maximum progress rate
9. List the experience of the principal individuals of your business
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
10. Information required to complete a responsibility determination if the apparent successful offeror.
a. Credit References
Company Name/Address Point of Contact Telephone number TYPE OF WORK
b. Banking Information.
Company Name/Address Point of Contact Telephone number TYPE OF WORK
11. REMARKS
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:
Name:
Title: Date:
File details come from the government source that posted it. Updated .