Attch5_RelevantExperienceSurvey_4pp.docx
DOCX document 26 KB Posted
- Attached to
- CO-ROCKY MTN ARSNL NWR-PATCH HILL ROAD
- Solicitation number
- 140FGA26Q0080
- Issued by
- Not on record
About this file
This is a Relevant Experience Survey appendix document designed to collect contractor qualifications and past project experience.
The survey requests detailed information about the contractor's background and capability to perform road repair and asphalt work. Contractors are required to provide documentation of relevant experience on similar projects, including project names, locations, completion dates, project costs, and descriptions of work performed. The survey appears to solicit information about the contractor's experience with asphalt surface repairs, road maintenance, and construction project management. Respondents must demonstrate their qualifications through examples of previously completed work of comparable scope and complexity. This document serves as an evaluation tool for the US Fish and Wildlife Service Rocky Mountain Arsenal National Wildlife Refuge to assess contractor capability prior to award of the asphalt repair contract for Patch Hill Road (Rattlesnake Hill Road). Contractors should prepare detailed accounts of relevant projects, including measurable outcomes and technical accomplishments, to substantiate their eligibility and competence for this federal construction opportunity.
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Text version
RFQ 140FGA26Q0080
FWS CO – Rocky Mtn Arsenal NWR Crackseal Entrance A Road
RELEVANT EXPERIENCE
Your Company Name:
Street Address:
City, State and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
| Company President: | Vice President: | |
| SAM.gov Unique Entity ID: | ___________________ |
Is company a: Partnership [ ] Separate entity [ ] Division [ ] N/A [ ]
2. CONTRACTS / SUBCONTRACTS COMPLETED OR IN PROGRESS
Complete and submit the information requested below on prime contracts or subcontracts completed or in progress. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress.
a. First Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | ||
| Contract Number: | Contract/Subcontract Amount: $ | _____ |
Project Title and Location:
General Scope of Project: ____________
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $
Period of Performance: days Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
b. Second Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | ||
| Contract Number: | Contract/Subcontract Amount: $ | _____ |
Project Title and Location:
General Scope of Project: ____________
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
c. Third Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | ||
| Contract Number: | Contract/Subcontract Amount: $ | _____ |
Project Title and Location:
General Scope of Project: ____________
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
Type or Print Information Name of Survey Preparer
Phone:
E-Mail Title__________________________________________ Signature______________________________________ Date__________________________________________ )4. Certification of Past Performance Information:
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