C04 4 EXPERIENCE QUESTIONAIRE 12444627Q0008.pdf
PDF 143 KB Posted
- Solicitation number
- 12444627Q0008
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form for a janitorial services contract with the Chippewa National Forest in Blackduck. By submitting an offer, contractors agree to all terms and conditions in the solicitation and must furnish awarded items at the quoted price, with offer validity lasting 60 days after the solicitation closing date unless formally extended.
The questionnaire requires offerors to provide company information including name, SAM UEI number, email address, and point of contact details, along with business type classification (company, corporation, non-profit, co-partner, or individual). Contractors must document years of experience in janitorial work and specify experience as prime and subcontractors, listing completed projects from the last three years with contract amounts, project types, completion dates, and reference contacts. Additional sections require disclosure of concurrent contractual commitments, work completion history, performance bond usage, delivery terms, and organizational capacity including minimum and maximum employee counts, payroll status, equipment and supplies to be used, and progress rates. Question 13 requests information on employees assigned to vehicle upfitting services with their experience levels. Contractors must provide a narrative describing their anticipated project approach and may include additional remarks. The form concludes with a certification statement attesting to the accuracy of all provided information and authorizing the Forest Service to verify capability through named references. All statements must be signed with the offeror's signature, title, and date.
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Text version
CHIPPEWA NF – BLACKDUCK
JANITORIAL
Experience Questionnaire (Please complete and submit the following with your offer.)
By submitting the offer, the Contractor agrees to all terms, conditions, clauses, and provisions included in the solicitation and agrees to furnish any awarded items at the price set in the schedule. The offer is valid for 60 after the closing date of the solicitation unless a formal extension is granted by the contractor.
OFFEROR NAME
OFFEROR SAM UEI NUMBER
OFFEROR EMAIL ADDRESS
OFFEROR POINT OF CONTACT (NAME AND PHONE)
Instructions: See Box 10, REMARKS. If extra space is needed to answer any items below. Mark "X" in the appropriate boxes.
Please list NA for inapplicable items.
1. Contractor's Name, Address & Telephone Number 2. Type of Business
Company Corporation
Non-profit Organization
Co-partner Individual
3. How many years of experience do you have in this line of work?
4. How many years of experience as a prime contractor? subcontractor?
5. List the projects your business has completed in the last 3 years.
Contract Amount
Type of Project Date Completed
Name and Telephone Number to Contact For Information
6. List contractual commitments running concurrently with the work contemplated by this soliciation.
Contract Number
Contract Amount
Type of Project Est. Date of Completion
Name and Telephone Number to Contact For Information
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 Question 7a. or 7b., please specify location(s) and reason(s):
8. List any special features of the supply reuqired for effective program performance.
9. Provide information on the probable life of the items selected in comparison to unchosen compatible items.
10. Provide warranty information and the avialability of maintenance and repair.
11. Detail delivery terms.
12. Organization that will be available for this project:
a. Minimum No. of employees: Maximum No. of employees:
b. Are employees regularly on your payroll? yes no
c. Specify supplies, tools, equipment (list model, horsepower, and pice size capabilities), and facilities to be used for this contract:
d. If applicable, estimate rate of progress (such as 2.0 acres per day):
Minimum progress rate: Maximum progress rate:
13. List the employees that would be assigned to perform vehicle upfitting services at the work site on this contract and their experience with vehicle upfitting:
Individual's Name Present Position Years Experience Type of Work
14. Please provide a brief narative which describes your anticipated approach to this project. The space below is not adequate for response. Please provide your response on an additional page(s).
15. Remarks: Additional pages may be added to provide additional information in this section.
CERTIFICATION: I certify that all of the statements made above 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.
Signature Title Date
| Experience Questionnaire |
| 15. Remarks: Additional pages may be added to provide additional information in this section. |
File details come from the government source that posted it. Updated .