Attachment4.1240LU26Q0121ExperienceQuestionnaire.pdf
PDF 90 KB Posted
- Solicitation number
- 1240LU26Q0121
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor qualifications for federal contract opportunities.
The questionnaire requires contractors to provide comprehensive information about their business experience and capability to perform work. Key sections include: contractor identification and business type (company, corporation, partnership, individual, or non-profit); years of experience in the line of work contemplated by the solicitation; years of experience as a prime contractor and/or subcontractor; and a detailed project history for the past three years showing contract amounts, project types, completion dates, and owner contact information for reference verification. The form also requires disclosure of any work that was not completed or required performance bond completion, with explanations of reasons and locations if applicable. Section 8 addresses organizational capacity, requesting minimum and maximum employee counts, confirmation of regular payroll status, and a detailed inventory of equipment available for the contract. Section 9 requires listing principal individuals in the business with their positions, years of experience, and descriptions of work magnitude and type. The form includes a certification statement wherein the certifying official attests that all information provided is complete and correct and authorizes the Forest Service to verify capability through named references. The questionnaire must be signed in ink by the certifying official with their title and date.
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Text version
USDA Forest Service (1/00)
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, Address, and Telephone Number
2. Submitted to (Office Name & 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 (or currently working) where we can confirm that your company has experience in similar work.
Contract Amount
Type of Project Ongoing or
Date Completed
Name, Address, and Telephone No.
of Owner/Person to Contract for
Project Information
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:
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
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