C04e - ATTACHMENT 5 - Experience Questionnaire.docx
DOCX document 23 KB Posted
- Solicitation number
- 12444626Q0003
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form designed to evaluate contractor qualifications for heritage-cultural resources survey work on the Chequamegon-Nicolet National Forest. The questionnaire serves as an appendix to the Request for Quote (RFQ) solicitation numbered 12444626Q0003 and functions as a qualification assessment tool rather than a detailed specification of work requirements.
The form appears to be a template for collecting information about prospective contractors' relevant experience, qualifications, and capabilities in conducting cultural and heritage resource surveys. As an evaluation instrument, it would typically gather details such as past project experience, team composition, technical expertise, equipment capabilities, and performance on similar National Register of Historic Places identification and evaluation work. Respondents would use this questionnaire to demonstrate their ability to perform field inventories, identify, record, and evaluate cultural and heritage resources (both pre-contact and post-contact manifestations 50 years or older) within designated project areas of the forest. The specific response requirements, evaluation criteria, and submission deadlines would be outlined in the primary RFQ document rather than this supporting appendix.
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Text version
CNF – Heritage Survey – Peerless Veg EA Offer Submission Package
Experience Questionnaire (Please complete and submit the following with your offer.)
By submitting the offer, the Contractor agrees to all terms, conditions, clauses, and provisions included in the solicitation and agrees to furnish any awarded items at the price set in the schedule. The offer is valid for 90 after the closing date of the solicitation unless a formal extension is granted by the contractor.
OFFEROR NAME __________________________________________________________
OFFEROR SAM UEI NUMBER _________________________________________________
OFFEROR EMAIL ADDRESS ________________________________________________
OFFEROR POINT OF CONTACT (NAME AND PHONE) _________________________________
Instructions: See Box 10, REMARKS. If extra space is needed to answer any items below. Mark "X" in the appropriate boxes.
Please list NA for inapplicable items.
| 1. Contractor's Name, Address & Telephone Number |
| 2. Type of Business |
____ Company
____ Corporation
____ Non-profit Organization
____ Co-partner
____ Individual
3. How many years of experience do you have in this line of work? ___________________
4. How many years of experience as a prime contractor? _________ subcontractor? ________
5. List the projects your business has completed in the last 3 years.
Contract Amount
| Type of Project |
| Date |
Completed Name and Telephone Number to Contact For Information
6. List contractual commitments running concurrently with the work contemplated by this soliciation.
Contract Number Contract Amount
| Type of Project |
| Est. Date of |
Completion Name and Telephone Number to Contact For Information
7a. Have you ever failed to complete any work awarded to you? ____ yes ____ no 7b. Has work ever been completed by performance bond? ____ yes ____ no 7c. If "yes" to either Question 7a. or 7b., please specify location(s) and reason(s):
8. Organization that will be available for this project:
| a. | Minimum No. of employees: _______________ Maximum No. of employees: ________________ |
| b. | Are employees regularly on your payroll? ____ yes ____ no |
| c. | Specify supplies, tools, equipment (list model, horsepower, and pice size capabilities), and facilities to be used for this contract: |
d. If applicable, estimate rate of progress (such as 2.0 acres per day):
Minimum progress rate: __________________________ Maximum progress rate: _____________________
9. List the employees that would be assigned to perform survey services at the work site on this contract and their experience with similar services:
| Individual's Name |
| Present Position |
| Years Experience |
| Type of Work |
10. Please provide a brief narative which describes your anticipated approach to this project. The space below is not adequate for response. Please provide your response on an additional page(s).
11. Remarks: Additional pages may be added to provide additional information in this section.
CERTIFICATION: I certify that all of the statements made above 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.
Signature Title Date
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