C4e_ Attachment E Experience Questionnaire.pdf
PDF 279 KB Posted
- Attached to
- Huron-Manistee NF Truck Build
- Solicitation number
- 12444626Q0055
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form used by the USDA Forest Service for contract solicitation 12444626Q0055. The form is a template designed to collect information about a contractor's qualifications and past performance to evaluate their capability to perform work for the Forest Service.
The questionnaire requires contractors to provide their business information, including name, address, contact details, UEI number, and business structure (company, corporation, co-partnership, individual, or non-profit organization). Contractors must document their experience in the relevant line of work and contracting history as prime contractors and/or subcontractors. The form requests a detailed listing of projects completed within the past three years, including contract amounts, project descriptions, completion dates, and owner contact information for reference verification. Additionally, contractors must disclose all concurrent contractual commitments and indicate whether they have ever failed to complete awarded work or required performance bonds to complete work, with explanations if applicable. The questionnaire also collects information about available resources, including minimum and maximum employee counts, payroll status, and estimated progress rates. Contractors must identify principal individuals in their organization with their positions, experience in years, and work magnitude and type. The form requires a comprehensive list of equipment and vehicles to be used on the contract with detailed descriptions and maintenance plans. Finally, contractors must describe their quality control and self-inspection procedures, safety plans, proposed work schedules, and any use of bio-based products or materials. All responses must be certified by an authorized official under penalty of perjury.
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Text version
Attachment D – Experience Questionnaire: 12444626Q0055
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 .