C04 Attachment 3 Experience Questionnaire.pdf
PDF 476 KB Posted
- Attached to
- GMUG Grand Valley RD Chimney Liner Replacement
- Solicitation number
- 1240LP26Q0144
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor qualifications for federal contract opportunities.
The questionnaire collects comprehensive information about a contractor's capability to perform work for the Forest Service. Section 1 requests basic contractor identification and business structure (company, corporation, co-partnership, individual, or non-profit organization). Section 4 asks about years of experience in the relevant line of work, while Section 5 differentiates between prime contractor and sub-contractor experience. Section 6 requires a three-year project history listing contract amounts, project types, completion dates, and owner contact information. Section 7 documents all concurrent contractual commitments, including contract numbers, award amounts, involved parties, units awarded, percent completion, and contract completion dates. Section 8 includes yes/no questions regarding failure to complete work, performance bond usage, and on-site project inspections. Section 9 addresses employee availability (minimum and maximum numbers), payroll status, equipment specifications, and estimated progress rates. Section 10 requires listing principal individuals directly involved in the contract, including their names, positions, years of experience, and work magnitude/type. Section 11 provides space for remarks and additional information supporting capability evaluation. The form concludes with a certification section requiring the certifying official's name, title, ink signature, and date, with language certifying statement accuracy and authorizing reference verification by the Forest Service.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| C04 Attachment 2 Schedule of items_Collbran chimney.xlsx | XLSX spreadsheet | |
| C04 1240LP26Q0144 Chimney Liner Solicitation.pdf | ||
| C04 Attachment 1 Statement of Work.pdf | ||
| C04 Attachment 4 Wage Determination.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .