C04c.Attachment 3-USFS ExpQ.pdf
PDF 37 KB Posted
- Attached to
- Cimarron RD- HVAC Package Unit Replace and Install Federal contract opportunity
- Solicitation number
- 1240LP26Q0125
About this file
This is a USDA Forest Service Experience Questionnaire template used to evaluate contractor qualifications and capability to perform solicited work.
The form requires contractors to provide comprehensive background information including business structure (company, corporation, co-partnership, individual, or non-profit organization), years of experience in the relevant line of work, and distinction between prime and sub-contractor experience. Contractors must list all projects completed within the last three years with contract amounts, completion dates, and owner contact information for verification. Section 7 requires disclosure of all concurrent contractual commitments, including contract numbers, dollar amounts, percent completion, and projected completion dates to assess capacity and potential conflicts. The questionnaire includes yes/no questions regarding failed work completion, performance bond invocations, and on-the-ground site visits. Contractors must specify minimum and maximum employee availability, payroll status, and available equipment. Section 9 requests estimated productivity rates (such as acres per man-day) at minimum and maximum levels. Section 10 requires detailed information on principal individuals directly involved in the contract, including their names, positions, years of experience, and magnitude and type of work performed. A remarks section (Box 11) allows for additional information supporting the contractor's capability. The form concludes with a certification statement requiring the certifying official's signature, title, and date, confirming accuracy of all statements and authorizing the Forest Service to verify the contractor's qualifications through named references.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| C04.1240LP26Q0125-Packaged Unit Replacment-Install.pdf | ||
| C04a.Attachment 1-WD 2015-5345 rev 28 date 5-13-26.pdf | ||
| C04b.Attachment 2-Past Performance Data Sheet.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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