C04 Attachment 5 Experience Questionaire.pdf
PDF 139 KB Posted
- Attached to
- Hog Removal Blanket Purchase Agreements
- Solicitation number
- 12444726Q0018
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form for a Wild Pig Removal contract opportunity (12444726Q0018, Attachment 05). The form is designed to collect information about contractor qualifications and capabilities for performance evaluation purposes.
The questionnaire requires contractors to provide: basic company information including business type (company, corporation, co-partner, non-profit, or individual); years of experience in wild pig removal work and as prime or subcontractors; detailed listing of up to three relevant projects completed within three years of solicitation issuance, including contract numbers, award amounts, completion dates, and work descriptions; current contract commitments with associated percentages of effort; employee capacity (minimum and maximum numbers with payroll status); available equipment specifications; and experience information for principal business individuals including names, positions, years of experience, and work types. The form also requires disclosure of any prior failures to complete awarded work. Respondents must certify the accuracy and completeness of their statements and authorize references to be contacted by the Forest Service to verify project performance capability. Additional space for remarks is available in Box 11 for responses requiring expansion. A signature block for authorized company representative with name, title, and date is included at the form's conclusion.
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Text version
12444726Q0018 Attachment 05 Wild Pig Removal
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
12444726Q0018 Attachment 05 Wild Pig Removal
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 .