C04d Experience Questionnaire 1240LT26Q0179.docx
DOCX document 34 KB Posted
- Attached to
- Big Springs Horse Corral Replacement
- Solicitation number
- 1240LT26Q0179
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form used by the USDA Forest Service to evaluate contractor qualifications for the Big Springs Horse Corral Replacement project (Solicitation Number 1240LT26Q0179). The questionnaire is submitted to Terri Tucker at terri.tucker@usda.gov and requires detailed information about the contractor's background, capacity, and relevant experience.
The form solicits critical information including contractor business structure and years of experience in the relevant line of work; history as prime and subcontractors; completed projects within the last three years involving similar general construction work, specifically concrete work and earthwork; and all concurrent contractual commitments with explanations of communication methods, quality assurance, inspection procedures, and dispute resolution. Respondents must disclose any failures to complete awarded work, whether work required performance bonds, and whether the project site was visited on-the-ground. The questionnaire also requires specification of available employees (minimum and maximum numbers, payroll status), equipment, progress rates, and detailed experience of principal individuals who will directly manage the contract. The form concludes with a certification section where the applicant attests to the accuracy and completeness of all statements provided. This questionnaire is a standard pre-award evaluation tool to assess contractor capability to successfully execute the corral replacement work, which involves supply and installation of steel oil pipe corrals with concrete post embedment and temporary traffic control, with optional work for an additional corral and hitching rail installation.
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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 General Construction 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. Concrete work
2. Earthwork
| 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.
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 .