C04h Experience Questionnaire 1240LT26Q0134.docx

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) Tony Taylor – tony.taylor@usda.gov

☐ 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: Comment by Taylor, Tony - FS, KY: Box 11. on page three may be used to elaborate. Identify in box 11 which project is being elaborated on.

Ex: 6. A - Excess material was properly disposed on this project by …

6. B - The requirements in this project’s specifications were met by ensuring ...

Quoters shall provide proof of electrical licensure in the State of Idaho and demonstrate experience completing projects with the following technical aspects:

· Knowledge and experience with prime-rated generator system installations;

· Knowledge and experience with flexware and battery backup system installations;

· Knowledge and experience with solar array and module installations;

· Knowledge and experience with general electrical system components (conduit, conductor, switch/receptacle, panelboard, disconnect, handhole, etc.) installations;

· Knowledge and experience with forming/pouring concrete pads and footings having rebar following contract drawings and specifications.

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?

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?)

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. Comment by Taylor, Tony - FS, KY: Example for elaboration of projects listed in Box 6:

6. A - Excess material was properly disposed on this project by …

6. B - The requirements in this project’s specifications were met by ensuring ...

CERTIFICATION

I certify that all of the statements made by me are complete and correct to the best of my knowledge, and that any person 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