C04_Attach 4_Experience Questionnaire.pdf
PDF 169 KB Posted
- Solicitation number
- 12443926Q0149
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form for the Barrens Rare Insect Survey contract opportunity (12443626Q0149). The form is a template designed to collect contractor qualifications and background information as part of the solicitation response requirements.
The questionnaire requests comprehensive organizational and experience data, including: contractor name, address, email, and phone contact information; business type classification (company, corporation, co-partner, non-profit, or individual); years of experience in the line of work and as a prime or subcontractor; listing of no more than three relevant projects completed within the past ten years with contract numbers, award amounts, contact references, completion dates, and work descriptions; current contract commitments with contract numbers, award amounts, and contact information; history of failed contract completions; organizational capacity including minimum and maximum employee counts, payroll status, and available equipment; and principal individuals' experience with names, present positions, years of experience, and work types. The form includes a remarks section for additional information and concludes with a certification statement requiring the respondent to verify the accuracy and completeness of all provided information and authorize references to contact the Forest Service to verify capability to perform the project. Respondents must sign the certification with their name, title, and date.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| C05_SF30_12443926Q0149_Amd_0001.pdf | ||
| C04_Attach 1_Schedule of Items.pdf | ||
| WD 2015-4821 Rev32.pdf | ||
| A04_Attach 2_SOW.pdf | ||
| C04_Attach3_Barrens Ecocsytem Maps.pdf | ||
| C04_SF1449_12443926Q0149.pdf | ||
| C04_12443926Q0149_Final.pdf |
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Text version
Barrens Rare Insect Survey 12443626Q0149 Attachment #4
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 10 years of this solicitation issuance date:
CONTRACT
NUMBER
AWARD
AMOUNT
NAME, ADDRESS, E-MAIL, &
PHONE NO. TO CONTACT
FOR INFORMATION.
DATE
CONTRACT
COMPLETED
DESCRIPTION OF
WORK PERFORMED
6. List all of your firms current contract commitments
CONTRACT
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
Barrens Rare Insect Survey 12443626Q0149 Attachment #4
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 .