B08_Solicitation_Attach_3_Experience_Questionnaire.xls
XLS spreadsheet 38 KB Posted
- Attached to
- BARN SPRINKLER REPAIR SERVICE
- Solicitation number
- 140P6326Q0026
About this file
This is an Experience Questionnaire form used by the National Park Service to evaluate contractor qualifications for the Portable Toilets project at Badlands National Park. The form requires prospective contractors to provide comprehensive information about their business capabilities, relevant experience, and financial standing to demonstrate their ability to perform the work.
The questionnaire requests detailed information across multiple categories: contractor identification and business structure; years of experience in the relevant line of work and as a prime contractor; a three-year project history including contract amounts, project types, completion dates, and references; current contract commitments with award amounts and completion status; disclosure of any failed or bonded work; organizational capacity including minimum and maximum employee availability and equipment resources; qualifications and experience of key personnel who will work on the project; and financial responsibility documentation from the contractor's financial institution. The form also includes a certification statement in which the contractor affirms their intent to complete the project as specified, confirms the accuracy of all information provided, and authorizes the National Park Service to verify their capability to perform. Contractors may complete the form manually or using Microsoft Excel, with additional space available in the remarks section for supplementary information. The form requires the contractor's signature, title, and date upon submission.
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Other files
| File | Type | Posted |
|---|---|---|
| B09_Solicitation_Amendment_1_Attach_1_Experience_Questionnaire_0001.xls | XLS spreadsheet | |
| Sol_140P6326Q0026_Amd_0001.pdf | ||
| B08_Solicitation_Attach_2_WD.pdf | ||
| B08_Solicitation_Attach_1_SOW.pdf | ||
| Sol_140P6326Q0026.pdf |
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Text version
Sheet1
| 1. Contractors Name, Address, & Telephone No.: | 2. Type of Business | ||||||
| Name: | |||||||
| Address: | Company | ||||||
| Corporation | |||||||
| Non-profit Org | |||||||
| Telephone No.: | Co-partner | ||||||
| SAM DUNS No: | 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 projects your business has completed in the last 3 years: | |||||||
| CONTRACT | |||||||
| AMOUNT | TYPE OF | ||||||
| PROJECT | DATE | ||||||
| COMPLETED | NAME, ADDRESS & TELEPHONE NO.TO |
CONTACT FOR INFORMATION
| 6. List all of your firms current contract commitments: | |||||
| CONTRACT | |||||
| NUMBER | AWARD | ||||
| AMOUNT | NAME, ADDRESS, & PHONE NO. | ||||
| TO CONTACT FOR INFORMATION | PERCENT | ||||
| COMPLETED | DATE |
COMPLETED
| 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 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? | Yes | No | ||||||||||||
| c. Specify equipment available for this project: | ||||||||||||||
| 9. List the experience of principal individuals with proper qualifications/certifications to be used on this project: | ||||||||||||||
| INDIVIDUALS | ||||||||||||||
| NAME | PRESENT | |||||||||||||
| POSITION | YEARS | |||||||||||||
| EXPERIENCE | TYPE 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 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 alternative 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 National Park Service with any information needed to verify my capability to perform this project. | ||||||||||||||
| SIGNATURE | TITLE | DATE |
EXPERIENCE QUESTIONNAIRE for Portable Toilets Badlands NP 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
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