C04_ATT3_Experience Questionnaire_1284LM26Q4001.docx
DOCX document 17 KB Posted
- Attached to
- Heritage Survey at Rabbit Ears Manganese Mine
- Solicitation number
- 1284LM26Q4001
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form required by the USDA Forest Service for contractors bidding on a BPA Call Order for Heritage Survey services at Rabbit Ears Manganese Mine for the Medicine Bow-Routt National Forests and Thunder Basin National Grassland (Solicitation Number 1284LM26Q4001).
The questionnaire requires contractors to provide comprehensive information about their qualifications and capacity to perform the work. Respondents must document their years of experience in the relevant line of work, distinguish between prime contractor and subcontractor experience, and list all projects completed within the last three years with contract amounts, project types, completion dates, and owner contact information. Contractors must also disclose all concurrent contractual commitments, including contract numbers, dollar amounts, percentage completion, and expected completion dates. The form requires contractors to answer yes/no questions regarding previous failure to complete awarded work, use of performance bonds, and on-site project visits. Contractors must specify the minimum and maximum number of employees available, confirm regular payroll status, list equipment, and provide estimated production rates. Additionally, contractors must provide detailed information on key personnel who will directly work on the contract, including their names, positions, years of experience, and relevant work experience. The questionnaire requires certification by an authorized official attesting to the accuracy and completeness of all statements provided. Questions regarding this solicitation should be directed to andrea.haines@usda.gov no later than May 12, 2026, at 3:00 PM Mountain Time.
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Text version
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.
1. Contractor Name, Address, and Telephone Number
2. Submitted to (Office Name and Address)
3. Business [ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual [ ] Non-profit Organization
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. How many years experience have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?
6. List below the projects your business has completed within the last three years:
| Contract Amount |
| Type of Project |
| Date Completed |
| Name, Address, and Telephone No. of Owner/Person to Contact for Project Information |
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
| Contract Number |
| Dollar Amt. of Award |
| Name, Address, and Telephone No. of Business/Government Agency Involved |
| Awarded (Units) |
| Percent Completed |
| Date Contract Complete |
8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No 8b. Has work ever been completed by performance bond? [ ] Yes [ ] No 8c. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:
EXPERIENCE QUESTIONNAIRE CONTINUED
9. Employees and equipment that will be available for this project:
a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____
b. Are employees regularly on your payroll: [ ] Yes [ ] No
c. Specify equipment available for this contract:______________________________________________________
d. Estimate rate of progress below (such as 2.0 acres/man/day):
(1) Minimum progress rate:________________ and (2) Maximum progress rate: _________________________
10. List below the experience of the principal individuals of your business: (Who will directly be involved in this contract?)
| Individual’s Name |
| Present Position |
| Years of Experience |
| Magnitude and Type of Work |
11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):
NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT.
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.
12a. CERTIFYING OFFICIAL’S NAME AND TITLE
| b. SIGNATURE (Sign in ink) |
| 13. DATE |
File details come from the government source that posted it. Updated .