C4d_ Attachment D Experience Questionnaire 12444626Q0060.pdf
PDF 350 KB Posted
- Attached to
- Superior NF Wastewater Tank Pumping and Disposal
- Solicitation number
- 12444626Q0060
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form required for USDA Forest Service contract solicitation 12444626Q0060, used to evaluate contractor qualifications and capability to perform proposed work.
The form requests comprehensive information about the contractor's background, capacity, and past performance. Section 1 requires basic contractor identification including name, address, telephone, UEI number, and email. Section 2 specifies the submission office, and Section 3 requests business structure classification (company, corporation, co-partnership, individual, or non-profit organization). Sections 4 and 5 request years of experience in the relevant line of work and contracting history as both prime and sub-contractors. Section 6 requires a detailed listing of projects completed within the past three years, including contract amounts, project descriptions, completion dates, and owner contact information for verification purposes.
Section 7 requests information on all concurrent contractual commitments, including contract numbers, award amounts, associated agencies, percentage of completion, and expected completion dates. Section 8 asks whether the contractor has failed to complete awarded work or had work completed by performance bond, with space to explain any affirmative responses. Section 9 addresses organizational capacity, requesting minimum and maximum employee numbers, payroll status, and estimated progress rates for the work. Section 10 requires listing principal individuals with their positions, years of experience, and work magnitude and type. Section 11 requires detailed descriptions of all equipment and vehicles planned for use, including maintenance plans. Section 12 requires description of contractor self-inspection procedures, quality control measures, safety plan, bio-based product usage, and proposed work schedule. The form concludes with certification language requiring the certifying official's signature and date.
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Text version
Attachment D – Experience Questionnaire: 12444626Q0060
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 .