C04d Attachment 3 Experience Questionnaire 1284LM26Q0067.docx
DOCX document 24 KB Posted
- Solicitation number
- 1284LM26Q0067
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form required for submission to the USDA Forest Service in response to Solicitation Number 1284LM26Q0067 for equine winter boarding and supplemental feeding services within 200 miles of the Flathead National Forest Office in Kalispell, Montana. The questionnaire serves as a template for vendors to demonstrate their qualifications and capability to perform the contracted work.
The form requires respondents to provide comprehensive information including contractor name and business type, years of experience in the relevant line of work, prime and subcontractor experience history, and detailed project completion records from the past three years with contract amounts, completion dates, and owner contact information. Contractors must also disclose current contractual commitments that would run concurrently with this work, specify whether previous work was completed on time or required performance bonds, and confirm on-site inspection of the project location. Additional sections require disclosure of available employees (minimum and maximum numbers), payroll status, equipment availability, and detailed experience of principal individuals who will directly work on the contract, including their positions, years of experience, and relevant work magnitude and type. The form must be certified by an authorized official, confirming the accuracy and completeness of all statements provided. This questionnaire is mandatory for evaluating contractor capability and responsibility under this small business set-aside solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| C05a SF-30 AMD 0001 1284LM26Q0067.pdf | ||
| C05b Q_As 1284LM26Q0067.docx | DOCX document | |
| C04b Attachment 1 Statement of Work 1284LM26Q0067.docx | DOCX document | |
| C04c Attachment 2 Wage Determination 1284LM26Q0067.pdf | ||
| C04a Combined Synopsis Solicitation 1284LM26Q0067.docx | DOCX document |
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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:
| 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:______________________________________________________
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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