Attachment4.1240LU26Q0122ExperienceQuestionnaire.pdf
PDF 90 KB Posted
- Solicitation number
- 1240LU26Q0122
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire template used to evaluate contractor qualifications for federal contract opportunities.
The questionnaire collects comprehensive information about a contractor's organizational capacity and past performance. Respondents must provide their company name, address, and telephone number; identify their business structure (company, corporation, partnership, individual, or non-profit); and document years of experience in the relevant line of work and contracting history as both prime and sub-contractors. Section 6 requires listing projects completed within the last three years (or currently ongoing) with similar work, including contract amounts, project types, completion dates, and owner contact information for reference verification. Sections 7a-7c address past performance issues, specifically whether the contractor has failed to complete awarded work or required performance bond completion, with detailed explanations required if applicable. Section 8 requests information about organizational resources, including minimum and maximum employee availability, whether employees are on regular payroll, and equipment specifications available for the contract. Section 9 requires listing principal individuals with their positions, years of experience, and work scope. The form includes a certification statement (Section 11) in which the certifying official attests that all information is complete and correct and authorizes references to verify the contractor's capability. The questionnaire allows for additional remarks and attachments as needed to fully address any questions.
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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
File details come from the government source that posted it. Updated .