C04_Attach 4_Experience Questionaire.pdf
PDF 121 KB Posted
- Attached to
- Native Savanna Seed Mix
- Solicitation number
- 12443926Q0096
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form for contract solicitation 12443926Q0096 related to Native Savanna Seed Mix, issued by the Forest Service.
The questionnaire requires contractors to provide comprehensive background information including contractor name, address, email, and phone contact; business type (Company, Co-Partner, Non-profit, Corporation, or Individual); and years of experience in the line of work, distinguishing between prime contractor and subcontractor experience. Contractors must list no more than three relevant projects completed within three years of the solicitation issuance date, including contract number, award amount, contact information, completion date, and work description. The form also requires listing all current contract commitments with contract numbers, award amounts, contact information, and percentage allocation. Additional organizational information must be provided, including minimum and maximum employee counts, payroll status, and available equipment for the contract. The form includes a section for principal individuals' experience, listing name, present position, years of experience, and type of work. Contractors must certify that all statements are complete and correct and authorize references to be contacted for capability verification. A remarks section (Box 10) is available for additional information if needed. The questionnaire concludes with signature blocks for name, title, and date.
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Text version
12443926Q0096 / Attachment 4 Native Savanna Seed Mix
NAME, ADDRESS, E-MAIL, & PHONE NO. TO
CONTACT FOR INFORMATION.
AWARD
AMOUNT
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
1. Contractors Name, Address & Telephone No. Email 2. Type of Business
Company Co-Partner Non-profit Corporation Individual
3. How many years of experience do you have in this line of work Yrs
4. How many years of experience as a prime contractor subcontractor
5. List no more than 3 most relevant projects your business has performed within 3 years of this solicitation issuance date:
CONTRACT
NUMBER
AWARD
AMOUNT
NAME, ADDRESS, E-MAIL, &
PHONE NO. TO CONTACT
FOR INFORMATION.
DATE
COMPLETED
DESCRIPTION OF
WORK PERFORMED
6. List all of your firms current contract commitments
NUMBER
7. Have you ever failed to complete any work awarded to you? yes no
8. Organization information available for this project:
a. Minimum # of employees: and Maximum # of employees:
b. Are employees regularly on your payroll: yes no
c. Specify equipment available for this contract:
PERCENT
12443926Q0096 / Attachment 4 Native Savanna Seed Mix
9. List the experience of the principal individuals of your business
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
10. REMARKS
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 .