C04h Experience Questionnaire.pdf
PDF 161 KB Posted
- Attached to
- Bitterroot NF Vault Toilet Pumping
- Solicitation number
- 1240LS26Q0055
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a USDA Forest Service Experience Questionnaire form for federal contract solicitation 1240LS26Q0055, Bitterroot NF Vault Toilet Pumping. The form is a template designed to collect contractor qualifications and capability information from bidders responding to this specific solicitation.
The questionnaire requires contractors to provide organizational details including business structure (company, corporation, partnership, individual, or non-profit), years of relevant experience in the line of work, and contracting history as prime and sub-contractors. Contractors must list projects completed within the last three years that demonstrate similar work experience, including contract amounts, project types, completion dates, and reference contact information. The form also requires disclosure of any failed contract completions or work completed under performance bond, with explanations of circumstances and locations. Contractors must detail workforce availability by specifying minimum and maximum employee counts, confirm whether employees are regularly on payroll, and itemize equipment available for the contract. Additionally, the form requests information on principal individuals within the business, including their names, residency, positions, years of experience, and the magnitude and type of work they have managed. The form concludes with a certification section requiring the certifying official's signature, name, title, and date, whereby the contractor attests to the accuracy and completeness of all statements provided and authorizes the Forest Service to verify capability information through named references.
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Text version
USDA Forest Service (1/00)
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 10, Remarks, if extra space is needed to answer any item below. Mark “x” in appropriate boxes.
1. Contractor Name, Address, Telephone Number, and Email
2. Submitted to (Office Name & 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 in contracting have you or your business had as a (a) prime contractor ________ and/or (b) sub-contractor ______?
6. List below the projects your business has completed within the last three years (or currently working) where we can confirm that your company has experience in similar work.
Contract Amount
Type of Project Ongoing or
Date Completed
Name, Address, and Telephone No.
of Owner/Person to Contract for
Project 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 item 7a or 7b specify location(s) and reason(s) why:
1240LS26Q0055
BITTERROOT NF VAULT TOILET PUMPING
EXPERIENCE QUESTIONNAIRE
8. Organization and work that will be available for this project:
a. (1) Minimum number of employees:__________ and a (2) Maximum number of employees:__________
b. Are employees regularly on your payroll? _____ Yes _____ No
c. Specify equipment available for this contract
9. List below the experience of the principal individuals of your business:
Individual’s Name
And City of Residence Present Position Years of
Exp.
Magnitude and Type of Work
10. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):
11. 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
12b. Signature (Sign in Ink) 13. Date
File details come from the government source that posted it. Updated .