C04d Experience Questionnaire_3 pages- Word Doc.docx
DOCX document 40 KB Posted
- Attached to
- Big Piney Office Interior Sewer Line Replacement
- Solicitation number
- 1240LT26Q0154
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an experience questionnaire form designed to evaluate contractor qualifications for the Big Piney Office Interior Sewer Line Replacement project. The questionnaire is a three-page assessment document used by the Department of Agriculture Forest Service to gather information about potential contractors' relevant experience and capabilities prior to award of the solicitation (1240LT26Q0154). The form serves as a qualification evaluation tool rather than a detailed scope of work or pricing document, allowing the government to assess whether respondents possess the necessary expertise and track record to successfully execute the sewer line replacement and related construction work at the Big Piney Ranger Station on the Bridger-Teton National Forest in Wyoming.
The questionnaire focuses on gathering evidence of contractors' past performance and experience in similar projects involving sewer line replacement, demolition work, concrete patching, plumbing fixture installation, and flooring restoration. By requesting detailed information about relevant projects, the evaluation committee can determine contractor qualifications before proceeding with formal bid evaluation or contract award. This pre-qualification approach helps ensure that only experienced contractors capable of managing the technical and logistical requirements of the 81-foot sewer line replacement project are considered for award.
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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 the demolition and reconstruction of facilities 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:
· Show your experience and knowledge with plumbing, carpentry work, and laminate flooring installation.
| 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 .