C04a_Experience Questionnaire_12444026Q0146.docx
DOCX document 30 KB Posted
- Solicitation number
- 12444026Q0146
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire template used to evaluate contractor qualifications for the Road Maintenance Services for the Ouachita National Forest solicitation (12444026Q0146), a Request for Quotation issued by the Department of Agriculture Forest Service. The questionnaire is designed for small business concerns responding to this Total Small Business Set-Aside acquisition, with a North American Industry Classification Standard Code of 237310 and a small business size standard threshold of $45 million.
The questionnaire requires contractors to provide comprehensive information including company details, years of experience in the relevant line of work, and experience as prime contractors or subcontractors. Respondents must document at least three relevant projects completed within the last three years, with detailed descriptions of work performed (including specific tasks such as grounds maintenance, erosion control, mulching, or forestry work), equipment used, safety requirements, contract numbers, award amounts, client information, and completion dates. Additional sections require disclosure of any failed work completion or performance bond situations, identification of principal individuals and their experience, credit references, and banking contact information. The form includes certification language requiring the respondent to attest that all statements are accurate and complete.
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| File | Type | Posted |
|---|---|---|
| C04_CSS_12444026Q0146.pdf |
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Text version
Instructions: See Box 9, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
| 1. Contractors Name, Address, Telephone No., & Email | |||
| 2. Type of Business | |||
| Company | Co-Partner _ | Non-profit | |
| Corporation | Individual CAGE: | DUNS: |
3. How many years experience do you have in this line of work Years
4. How many years experience as a Prime Contractor Subcontractor
5. LIST OF RELATIVE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST
THREE (3) YEARS
NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included. (i.e., what tasks were performed, (grounds maintenance, erosion control, mulching, forestry work performed, type of equipment used, special safety or requirements) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Contract Number: Award Amount: Client/Company’s Name/Address:
| Contact Name and Telephone number: | Description of Work Performed: | |
| _ |
Date completed or scheduled for completion:
Contract Number: Award Amount: Client/Company’s Name/Address:
| Contact Name and Telephone number: | Description of Work Performed: |
| _ |
Date completed or scheduled for completion:
12444026Q
ATTACHMENT
RELEVANT
EXPERIENCE
QUESTIONNAIRE
Contract Number: Award Amount: Client/Company’s Name/Address:
| Contact Name and Telephone number: | _ Description of Work Performed: |
| _ |
Date completed or scheduled for completion:
Contract Number: Award Amount: Client/Company’s Name/Address:
| Contact Name and Telephone number: | Description of Work Performed: |
| _ |
Date completed or scheduled for completion:
Contract Number: Award Amount: Client/Company’s Name/Address:
| Contact Name and Telephone number: | Description of Work Performed: |
| _ |
Date completed or scheduled for completion:
6a. Have you ever failed to complete any work awarded to you? Yes No
6b. Has work ever been completed by performance bond? Yes No
| 6. If "yes" to either item 7a or 7b specify location(s) and reason(s) why: |
| _ |
7. List the experience of the principal individuals of your business:
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
8. Information required to complete a responsibility determination of the apparent successful offeror. (Additional information may be requested once a contractor is selected for award.. Moreover, the contractor might need to provide additional authorization from a creditor to grant access.)
a. Credit References:
Company Name/Address Point of Contact Telephone number Materials/Services Provided
b. Banking Information. (please do NOT provide account information – just a point of contact and a way to reach them) Company Name/Address Point of Contact Telephone number
9. REMARKS (Additional sheets may be attached to the experience questionnaire)
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: |
Any Additional Information:
File details come from the government source that posted it. Updated .