C06_Attachment 5_Optional Experience Questionnaire_12444526Q0082.docx
DOCX document 21 KB Posted
- Attached to
- Eddyville Quarters Window Replacement
- Solicitation number
- 12444526Q0082
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form used by the USDA Forest Service to evaluate contractor qualifications for federal solicitations. The form requires contractors to provide comprehensive background information including company structure, years of experience in the relevant line of work, and prime and subcontractor experience. Contractors must list all projects completed within the last three years with contract amounts, project descriptions, completion dates, and owner contact information, as well as detail all current contractual commitments running concurrently with the proposed work, including contract numbers, dollar amounts, percent completion, and expected completion dates.
The questionnaire also requires contractors to disclose any failure to complete awarded work or instances where work was completed via performance bond, along with explanations. Contractors must provide organizational capacity information including minimum and maximum employee availability, payroll status, and estimated progress rates. Additionally, the form requires documentation of key personnel experience, detailed equipment lists with maintenance plans, and contractor quality control and safety procedures. For the referenced solicitation 12444526Q0082 (Eddyville Quarters Window Replacement), this questionnaire would be submitted to support a Request for Quotation for commercial construction involving removal and installation of nineteen energy-efficient vinyl-clad windows at a residential facility, classified as a commercial action under FAR Parts 12 and 13 and subject to Service Contract Labor Standards.
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Text version
Attachment F – Experience Questionnaire
| USDA – Forest Service |
| EXPERIENCE QUESTIONNAIRE (Ref. FSH 6309.31 and 41 USC 1) |
INSTRUCTIONS: See Box 13, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
UEI (Formerly DUNS #) _____________________ E-Mail #_____________________
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 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:
CONTRACT
AMOUNT
TYPE OF PROJECT/DESCRIPTION
DATE
COMPLETED
NAME, ADDRESS, AND TELEPHONE NO. OF
OWNER/PERSON TO CONTACT FOR PROJECT
INFORMATION
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
| CONTRACT NUMBER |
| DOLLAR AMT. OF AWARD |
| NAME, ADDRESS, AND TELEPHONE NO. OF BUSINESS/GOVERNMENT AGENCY INVOLVED |
| AWARDED |
(Units)
PERCENT
COMPLETED
DATE CONTRACT COMPLETED
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. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why:
Previous edition is obsolete (OVER) FS-6300-27 (3/00)
9. Organization and work that will be available for this project.
a. (1) Minimum number of employees: _____ and Maximum number of employees: _____
b. Are employees regularly on your payroll: Yes No
c. 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:
INDIVIDUAL’S NAME
PRESENT
POSITION
YEARS
OF EXP.
MAGNITUDE AND TYPE OF WORK
11. List all the equipment (including vehicles) you plan to use on this contract. Provide a detailed description of the Equipment including your maintenance plan.
12. Contractor Inspection/Quality Control, Safety Plan, and Proposed Schedule. Describe Contractor Self Inspection Procedures which you will use to insure quality for this contract. Please include information on the purchase and use of any bio-based products & materials to be used on this project, a brief safety plan, and your planned schedule of work.
13. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
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 name 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 .