C04 Attachment 4 Exp Questionnaire.pdf
PDF 37 KB Posted
- Attached to
- Creede Visitor's Center Janitorial Services
- Solicitation number
- 1240LP26Q0087
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire template used to evaluate contractor capability and qualifications for solicited work.
The questionnaire collects comprehensive information about a contractor's background, experience, and resources. Required information includes contractor identification and business type (company, corporation, co-partnership, individual, or non-profit organization); years of experience in the specific line of work; years of experience as prime contractor and/or sub-contractor; completed projects within the last three years with contract amounts, completion dates, and owner contact information; and current contractual commitments running concurrently with the proposed work, including contract numbers, dollar amounts, units awarded, percent completion, and completion dates. The form also requests disclosure of any failed projects or work completed under performance bond, and confirmation of on-the-ground site visits. Sections 9 and 10 request information on employee availability (minimum and maximum numbers and payroll status), equipment specification, progress rate estimates, and experience of principal individuals directly involved in contract performance. The questionnaire includes a certification statement requiring the submitting official to attest that all statements are complete and correct and that named references are authorized to verify the contractor's capability. Respondents may attach additional sheets to Box 11 (Remarks) to provide supplementary information relevant to project completion capability.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1240LP26Q0087.pdf | ||
| C04 Attachment 1 Performance Work Statement.pdf | ||
| C04 Attachment 5 15-5433 Wage Determination Mineral County.txt | TXT text file | |
| C04 Attachment 2 Schedule of Items.pdf | ||
| C04 Attachment 3 Building Diagram.pdf |
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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:
Number
Dollar Amt.
of Award
Name, Address, and Telephone No. of Business/Government Agency Involved
Awarded (Units)
Percent Completed
Date
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
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