B08_Attachment_2_Relevant_Experience_Questionnaire.docx
DOCX document 33 KB Posted
- Solicitation number
- 140F0S26Q0040
About this file
This is a Relative Experience Questionnaire template designed to evaluate contractor qualifications for federal solicitation AG-4670-S-16-0138, which pertains to Well and Solar Panel/Windmill Maintenance, Repair, and Installation services for a 10-year Blanket Purchase Agreement (BPA) at Fort Niobrara National Wildlife Refuge under the Department of the Interior Fish and Wildlife Service.
The questionnaire requires contractors to provide company information including business type, CAGE and DUNS numbers, and years of relevant experience as both prime contractors and subcontractors. Contractors must document up to five completed projects from the past three years with specific details including contract numbers, award amounts, client information, contact references, and comprehensive descriptions of work performed (such as grounds maintenance, erosion control, mulching, forestry work, and equipment used). The form also requests information on principal individuals' experience and qualifications, credit and banking references for responsibility determination purposes, and requires disclosure of any work failures or performance bond completions. All statements must be certified as complete and correct, with references authorized to verify the contractor's capability to perform the project.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140F0S26Q0040.pdf | ||
| B08_Attachment_3_Well_Maintenance_Pricing_Worksheet.xlsx | XLSX spreadsheet | |
| B08_Attachment_1_QASP.docx | DOCX document |
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Text version
AG-4670-S-16-0138
ATTACHMENT 3
RELATIVE EXPERIENCE QUESTIONNAIRE
RELATIVE EXPERIENCE QUESTIONNAIRE
Instructions: See Box 9, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
1. Contractors Name, Address, Telephone No., & Email
2. Type of Business _Yes:_Company __Co-Partner __Non-profit __Corporation __Individual
CAGE: DUNS:
3. How many years experience do you have in this line of work____
4. How many years experience as a prime contractor_____ subcontractor___
5. LIST OF RELATIVE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE (3) YEARS
NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included. (i.e., what tasks were performed, (grounds maintenance, erosion control, mulching, forestry work performed, type of equipment used, special safety or requirements) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________________________________________________________________________________________________________________________________________________ Contact Name and Telephone number: _______________________________ Description of Work Performed: ________________________________________________________________________________________________________________________________________________________________________________________________________________ Date completed or scheduled for completion: __Project was competed on time________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: __________________________________________________________________________________________________________________________________________________________________________________________________________________ Contact Name and Telephone number: ____________________ Description of Work Performed: ___________________________________________________________________________ Date completed or scheduled for completion: __
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________ Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________ Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________
Date completed or scheduled for completion: ______________________________________________________________
Contract Number:______________________________________ Award Amount: _________________________________ Client/Company’s Name/Address: ________________________________________________________________________ Contact Name and Telephone number: ____________________________________________________________________ Description of Work Performed: _________________________________________________________________________ Date completed or scheduled for completion: ______________________________________________________________
6a. Have you ever failed to complete any work awarded to you? __yes __ no
6b. Has work ever been completed by performance bond? __yes __ no
6. If "yes" to either item 7a or 7b specify location(s) and reason(s) why
7. List the experience of the principal individuals of your business
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
8. Information required to complete a responsibility determination of the apparent successful offeror. (Additional information may be requested once a contractor is selected for award.. Moreover, the contractor might need to provide additional authorization from a creditor to grant access.)
a. Credit References
| Company Name/Address |
| Point of Contact |
| Telephone number |
| Materials/Services Provided |
b. Banking Information. (please do NOT provide account information – just a point of contact and a way to reach them)
| Company Name/Address |
| Point of Contact |
| Telephone number |
9. REMARKS (Additional sheets may be attached to the experience questionnaire)
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:
Name:
| Title: |
| Date: |
File details come from the government source that posted it. Updated .