C04e - Experience Questionnaire.pdf
PDF 189 KB Posted
- Attached to
- SUMMIT VIEW WATER SYSTEM PIPE REPLACEMENT
- Solicitation number
- 1240LT26Q0136
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form used to evaluate contractor qualifications for solicited work related to roofing and reroofing of facilities.
The questionnaire requires contractors to provide their company information, including name, address, telephone number, and SAM UEI, along with business structure designation (company, corporation, co-partnership, individual, or non-profit organization). Contractors must document their years of experience in the relevant line of work and specify experience as either prime contractors or sub-contractors. The form requires detailed descriptions of roofing and reroofing projects completed within the last three years that are similar to those outlined in the Statement of Work (SOW), with specific emphasis on removal and proper disposal of existing roofing systems, installation of new roofing systems, metal fabrication work for roofing, and ability to meet project specifications. Contractors must list up to six past projects with contract amounts, completion dates, and reference contacts for verification. The questionnaire also requests information on all concurrent contractual commitments, including contract numbers, award amounts, completion percentages, and dates of contract completion. Additionally, contractors must disclose whether they have ever failed to complete awarded work, had work completed by performance bond, or conducted on-the-ground site inspections. The form requires documentation of available employees (minimum and maximum numbers), equipment specifications, estimated progress rates, and the experience of principal individuals who will directly work on the contract. A certification section requires the official company representative to sign and date the document, affirming that all statements are accurate and complete.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| C04_1240LT26Q0136_RFQ.pdf | ||
| C04b_Specifications.pdf | ||
| C04c_Drawings Summit Complete Package Signatures.pdf | ||
| C04f - Past Performance Data Sheet.pdf | ||
| C04_1240LT26Q0136_RFQ.pdf | ||
| C04b_Specifications.pdf | ||
| C04d_SAM_Wage Determination_ID20260021 051820.pdf | ||
| C04a_Schedule of Items.xlsx | XLSX spreadsheet |
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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, SAM UEI
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 that include the roofing and/or the reroofing 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:
o Tell how you removed and properly disposed of roofing systems similar to that listed in the SOW.
o Tell how you installed roofing systems similar to that listed in the SOW.
o Tell how you have worked with metal fabrication for roofing requirements similar to that listed in the SOW.
o Explain your Ability to meet past project requirements according to provided specifications.
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
6.F
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:
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
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:
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 .