C04. Attachment 5_ Past Performance Data Sheet.pdf
PDF 34 KB Posted
- Attached to
- South Park Ranger District Janitorial Services
- Solicitation number
- 1240LP26Q0166
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor capability and qualifications for Forest Service contract opportunities.
The form requires contractors to provide comprehensive background information including company name, address, business structure (company, corporation, co-partnership, individual, or non-profit organization), and years of experience in the relevant line of work. Contractors must document both prime contractor and sub-contractor experience levels. Section 6 requires listing all projects completed within the last three years with contract amounts, project types, completion dates, and owner contact information. Section 7 requires disclosure of all concurrent contractual commitments showing contract numbers, award amounts, business/government agency names, percent completion, and contract completion dates. The form includes yes/no questions regarding failure to complete awarded work, performance bond completion, and on-the-ground site inspection. Contractors must detail available employees (minimum and maximum numbers and payroll status), equipment specifications, and estimated progress rates. Section 10 requires listing principal individuals who will directly work on the contract, including their names, positions, years of experience, and magnitude and type of work. The form concludes with a certification section where the authorized official must sign and date the document, confirming that all statements are complete and correct and that named references are authorized to verify capability to perform the project.
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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
File details come from the government source that posted it. Updated .