C04c Experience Questionnaire 1240LT27Q0012.docx
DOCX document 40 KB Posted
- Attached to
- Nelson Drive Fuel Tank Removal
- Solicitation number
- 1240LT27Q0012
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form for the USDA Forest Service Solicitation 1240LT27Q0012, which pertains to the Nelson Drive Fuel Tank Removal project on the Bridger-Teton National Forest. The questionnaire is submitted to Terri Tucker at terri.tucker@usda.gov and serves as a pre-qualification evaluation tool to assess contractor capability to perform the work. Respondents must provide company information, business structure classification, years of relevant experience as prime and subcontractors, and detailed project history from the past three years that demonstrates similar work completion. The form requires contractors to identify concurrent contractual commitments, explain communication and quality assurance methods used on previous projects, and address any failed work completion or performance bond circumstances.
The questionnaire further requires contractors to specify available personnel and equipment for the project, including minimum and maximum employee requirements, payroll status confirmation, and estimated work progress rates. A critical section requires listing principal individuals directly involved in contract performance with their experience and work history. Contractors must certify the accuracy and completeness of all statements provided and acknowledge that listed references are authorized to provide verification information to the Forest Service regarding capability to perform the project. This form functions as a technical and management evaluation document rather than addressing specific pricing, award dates, or contract vehicles, and is essential for determining contractor qualification for the underground fuel storage tank removal and contaminated soil remediation work outlined in the solicitation.
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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 Email, SAM UEI.
2. Submitted to (Office Name and Address) Terri Tucker via email terri.tucker@usda.gov
| 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 that include ___________________________________________ similar to those listed in the SOW that your business has completed within the last three years. Highlight the following factors in the Type of Project Section:
| 1. |
| 2. |
| 3. |
| 4. |
| Box # |
| Contract Amount |
| Type of Project |
| Date Completed |
| Name, Address, and Telephone No. of Owner/Person to Contact for Project Information |
6. A
6. B
6. C
6. D
6. E
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation. Explain how you have kept in contact with the entity over the contract. What were the communication methods? How did you ensure that the product is what was wanted. How was the project inspected. How have you handled disputes if any?
| Contract Number |
| Dollar Amt. of Award |
| Name, Address, and Telephone No. of Business/Government Agency Involved |
| Awarded (Units) |
| Percent Completed |
| Date Contract 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 (This box will extend as information is added to accommodate extra space.):
NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT. (Examples for elaboration of projects listed in Box 6).
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 .