C04 Attachment 5 Experience Questionaire.pdf
PDF 136 KB Posted
- Solicitation number
- 12444726Q0030
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form (Attachment 04) for solicitation 12444726Q0030 regarding Backpack Foliar Herbicide services. The form is a template designed to collect contractor qualifications and experience data for evaluation purposes.
The questionnaire requires contractors to provide: basic company information and business type classification; years of experience in the line of work and as prime or subcontractors; up to three relevant projects completed within three years of solicitation issuance, including contract numbers, award amounts, contact information, completion dates, and work descriptions; current contract commitments with contract numbers, award amounts, contact information, and resource allocation percentages; a yes/no disclosure regarding failure to complete awarded work; organizational capacity details including minimum and maximum employee counts, payroll status, and available equipment; and principal individual experience including names, positions, years of experience, and type of work performed. The form includes a certification section requiring the submitting official to attest that all statements are complete and correct, and that named references are authorized to provide verification information to the Forest Service regarding capability to perform the project. Additional space for supplemental responses is available in a remarks section.
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Text version
12444726Q0030 Attachment 04
BACKPACK FOLIAR HERBICIDE
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:
9. List the experience of the principal individuals of your business
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
PERCENT
12444726Q0030 Attachment 04
BACKPACK FOLIAR HERBICIDE
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 .