Attch4_Questionnaire_2pp-fillable.pdf
PDF 195 KB Posted
- Attached to
- MT-ENNIS NFH-WINDOWS & DOOR REPLACEMENT Federal contract opportunity
- Solicitation number
- 140FC124Q0025
About this file
This document is a Past Experience & References Questionnaire for a federal contract opportunity. The key details are:
The U.S. Fish and Wildlife Service has a requirement for the replacement of 14 windows and 1 French door at the Ennis National Fish Hatchery in Ennis, MT. This is a small business set-aside contract with a total estimated value under $25,000. The questionnaire requests information on the contractor's business type, years of experience, past performance, and key personnel qualifications. Three contract references must be provided with details on the scope, value, and point of contact for each. The contract award will be based on a best value determination considering price, technical, and past performance factors. Interested contractors are encouraged to conduct a site visit.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_140FC124Q0025_Amd_0001.pdf | ||
| Attch1_SOW_2024_ENN_Replace14Windows-1FrenchDoor_2pp.pdf | ||
| Attch2_WD_MT20240016_v1-5-2024_MadisonCo_5pp.pdf | ||
| Attch3_BidSchedule_1p.docx | DOCX document | |
| Sol_140FC124Q0025.pdf |
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Text version
PAST EXPERIENCE & REFERENCES QUESTIONNAIRE
Instructions: This form may be completed manually or by using Adobe. See Box X, remarks, if extra space is needed to answer an item below. Mark “x” in the appropriate boxes.
1. Contractor’s Name, Address & Telephone No.:
Name:
Address:
Email Address:
Telephone No.:
SAM EUI No.:
2. Type of Business
Corporation Non-Profit Org Partnership Sole Proprietor Other (describe)
To receive consideration, complete and submit the information requested below with your quote. If additional space is needed, this form may be duplicated as necessary or you can provide your own form.
3. How many years’ experience does your business have in this line of work? Years
4. How many years’ experience as a prime contractor? Years
5. Have you ever Failed to Complete any work awarded to you? Yes No If “yes”, specify the reasons why.
6. References and Relevant Past Performance/Experience:
Experience must have been completed within the past three (3) years and be similar in size and complexity to those stated in the Scope of Work. Government contracts are preferred, but if you have not performed Government contracts, indicate any other contracts completed or in progress.
a. First Contract Reference:
Contract Agency or Company Name
Contract Number (if applicable)
Total Contract $ Value
Point of Contact (POC) Name
POC Telephone Number
POC E-mail address
Contract Start and End Date
Scope of Project: Provide sufficient detail for the Government to perform an evaluation)
b. Second Contract Reference:
Contract Agency or Company Name
Contract Number (if applicable)
Total Contract $ Value
Point of Contact (POC) Name
POC Telephone Number
POC E-mail address
Contract Start and End Date
Scope of Project: Provide sufficient detail for the Government to perform an evaluation)
c. Third Contract Reference:
Contract Agency or Company Name
Contract Number (if applicable)
Total Contract $ Value
Point of Contact (POC) Name
POC Telephone Number
POC E-mail address
Contract Start and End Date
Scope of Project: Provide sufficient detail for the Government to perform an evaluation)
7. List the experience of principal individuals with proper qualifications/certifications to be used on this project:
Individual’s Name Present Position Years Experience Type of Work
8. Remarks:
CERTIFICATION: I certify that I intend to complete the project as specified and that my offer conforms to the specifications of the solicitation without deviation unless I provide an alternate proposal. All 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 US Fish and Wildlife Service with any information needed to verify my capability to perform this project.
Signature Title Date
| Name: |
| Address: |
| AddressRow1: |
| AddressRow2: |
| Email Address: |
| Telephone No: |
| SAM EUI No: |
| Contract Agency or Company Name: |
| Contract Number if applicable: |
| Total Contract Value: |
| Point of Contact POC Name: |
| POC Telephone Number: |
| POC Email address: |
| Contract Start and End Date: |
| Scope of Project Provide sufficient detail for the Government to perform an evaluation: |
| Contract Agency or Company Name_2: |
| Contract Number if applicable_2: |
| Total Contract Value_2: |
| Point of Contact POC Name_2: |
| POC Telephone Number_2: |
| POC Email address_2: |
| Contract Start and End Date_2: |
| Scope of Project Provide sufficient detail for the Government to perform an evaluation_2: |
| Contract Agency or Company Name_3: |
| Contract Number if applicable_3: |
| Total Contract Value_3: |
| Point of Contact POC Name_3: |
| POC Telephone Number_3: |
| POC Email address_3: |
| Contract Start and End Date_3: |
| Scope of Project Provide sufficient detail for the Government to perform an evaluation_3: |
| Individuals NameRow1: |
| Present PositionRow1: |
| Years ExperienceRow1: |
| Type of WorkRow1: |
| Individuals NameRow2: |
| Present PositionRow2: |
| Years ExperienceRow2: |
| Type of WorkRow2: |
| Individuals NameRow3: |
| Present PositionRow3: |
| Years ExperienceRow3: |
| Type of WorkRow3: |
| Title: |
| Date: |
| Type of Business Describe: |
| Check Box1: Off |
| Check Box3: Off |
| Check Box2: Off |
| Check Box4: Off |
| Check Box5: Off |
| Yrs Experience: |
| Yrs Exp Prime: |
| Check Box8: Off |
| Check Box9: Off |
| Remarks: |
| Text1: USFWS MT – Ennis National Fish Hatchery 140FC124Q0025 |
Quarters (14) Windows & (1) French Door Replacement
File details come from the government source that posted it. Updated .