B08_Solicitation_attach_3_Experience_Questionaire.xls

XLS spreadsheet 38 KB Posted

Attached to
MIMI Seal and Coat 3 Asphalt Parking Lots
Solicitation number
140P6326Q0014
Issued by

About this file

This is an Experience Questionnaire form required as part of a Request for Quotation (RFQ) solicitation numbered 140P6326Q0014 for seal and coat services on three asphalt parking lots at Minuteman Missile Historic National Site, issued by the Department of the Interior National Park Service Midwest Region.

The questionnaire collects detailed information about contractor qualifications and capacity to perform the work. Respondents must provide company information including business type (corporation, non-profit, or individual), UEI number, and contact details; years of experience in the field and as a prime contractor; and a comprehensive list of similar road and parking lot projects completed within the last three years with contract amounts, project types, completion dates, and reference contacts. The form requires disclosure of all current contract commitments including contract numbers, award amounts, percent completed, and completion dates. Contractors must also declare any history of incomplete work or projects requiring performance bonds, with explanations if applicable. Additional requirements include specifying the organization's staffing availability (minimum and maximum employee numbers and whether employees are on regular payroll), listing equipment available for the project, and providing experience details of principal individuals who will work on the project. Financial responsibility documentation is required, either through completion of the financial information section or submission of a letter from a financial institution addressing account status. The form includes a certification statement requiring the contractor to attest that all information provided is complete and correct and that named references are authorized to verify their capability to perform the work.

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Sheet1

1. Contractors Name, Address, & Telephone No.:2. Type of Business
Name:
Address:Company
Corporation
UEI #:Non-profit Org
Telephone No.:Co-partner
Individual
3. How many years experience do you have in this line of work?Years
4. How many years experience as a prime contractor?Years
5. List the road/parking lot projects your business has completed in the last 3 years:
CONTRACT
AMOUNTTYPE OF
PROJECTDATE
COMPLETEDNAME, ADDRESS & TELEPHONE NO.TO

CONTACT FOR INFORMATION

6. List all of your firms current contract commitments:
CONTRACT
NUMBERAWARD
AMOUNTNAME, ADDRESS, & PHONE NO.
TO CONTACT FOR INFORMATIONPERCENT
COMPLETEDDATE

COMPLETED

7a. Have you ever failed to complete any work awarded to you?YesNo
7b. Has work ever been completed by performance bond?YesNo
7c. If "Yes" to either item 7a or 7b, specify locations and reason why:
8. Organization that will be available for this project:
a. Minimum No. of employees:and maximum No. of employees:
b. Are employees regularly on your payroll?YesNo
c. Specify equipment available for this project:
9. List the experience of principal individuals to be used on this project:
INDIVIDUALS
NAMEPRESENT
POSITIONYEARS
EXPERIENCETYPE OF WORK
10. Financial Responsibility:
(in lieu of this, you may submit a letter from your
financial institution that addresses the status and standing of your accounts)
Name of Financial Institution
Address:
Contact Name
Contact Phone Nbr
11. Remarks
CERTIFICATION: I certify that 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 National Park Service with any information needed to verify my capability to perform this project.
NAMETITLEDATE

EXPERIENCE QUESTIONNAIRE

Instructions: This form may be completed manually or by using MS Excel. See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

Sheet2

Sheet3

File details come from the government source that posted it. Updated .