ATTACHMENT G experience Questionnaire.pdf
PDF 208 KB Posted
- Solicitation number
- 12444626Q0034
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form (FS-6300-27) required by the USDA Forest Service for federal contract solicitations, referenced in FSH 6309.31 and 41 USC 1.
The form requires contractors to provide comprehensive background information to demonstrate capability and qualifications. Contractors must supply basic company details including name, address, telephone, UEI number, and email, along with business classification (company, corporation, co-partnership, individual, or non-profit organization). The questionnaire requests years of experience in the specific line of work, contracting experience as both prime and sub-contractors, and a detailed three-year project history listing contract amounts, project types, completion dates, and owner contact information. Contractors must also disclose all concurrent contractual commitments with dollar amounts, percent completion status, and expected completion dates. The form includes yes/no questions regarding failure to complete awarded work or completion via performance bond, with required explanation if applicable. Additionally, contractors must detail organizational capacity including minimum and maximum employee availability, payroll status, and estimated progress rates (measured in units such as acres per man-day). The form requires listing principal individuals with their positions, years of experience, and work magnitude/type, along with a comprehensive equipment inventory including vehicles and maintenance plans. Section 12 requests contractor self-inspection procedures, quality control measures, safety plans, information on bio-based products and materials usage, and a proposed work schedule. A certification statement signed by an authorized official confirms the accuracy of all submitted information and authorizes the Forest Service to verify the contractor's project performance capability.
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Text version
Attachment F – Experience Questionnaire
USDA – Forest Service
EXPERIENCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 13, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
UEI (Formerly DUNS #) _____________________
E-Mail #_____________________
2. SUBMITTED TO (office Name and Address)
3. BUSINESS
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:
CONTRACT
AMOUNT
TYPE OF PROJECT/DESCRIPTION
DATE
COMPLETED
NAME, ADDRESS, AND TELEPHONE NO. OF
OWNER/PERSON TO CONTACT FOR PROJECT
INFORMATION
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
CONTRACT
NUMBER
DOLLAR AMT.
OF AWARD
NAME, ADDRESS, AND TELEPHONE NO. OF
BUSINESS/GOVERNMENT AGENCY INVOLVED
AWARDED
(Units)
PERCENT
COMPLETED
DATE CONTRACT
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. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why:
Previous edition is obsolete (OVER) FS-6300-27 (3/00)
9. Organization and work that will be available for this project.
a. (1) Minimum number of employees: _____ and Maximum number of employees: _____
b. Are employees regularly on your payroll: Yes No
c. Estimate rate of progress below (such as 2.0 acres/man/day)
(1) Minimum progress rate: ________________________________ and (2) maximum progress rate: ________________________
10. List below the experience of the principal individuals of your business:
INDIVIDUAL’S NAME
PRESENT
POSITION
YEARS
OF EXP.
MAGNITUDE AND TYPE OF WORK
11. List all the equipment (including vehicles) you plan to use on this contract. Provide a detailed description of the Equipment including your maintenance plan.
12. Contractor Inspection/Quality Control, Safety Plan, and Proposed Schedule. Describe Contractor Self Inspection Procedures which you will use to insure quality for this contract. Please include information on the purchase and use of any bio-based products
& materials to be used on this project, a brief safety plan, and your planned schedule of work.
13. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
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 name 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
b. SIGNATURE (Sign in ink) 13. DATE
File details come from the government source that posted it. Updated .