CO4 D ATTACHMENT D Experience Quest12444626Q0049.pdf

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Attached to
Spring Cleanup Lawn Mowing/Weed Whip/Fall clean up on the Deer River Ranger District Compound per statement of work.
Solicitation number
12444626Q0049
Issued by

About this file

This is an Experience Questionnaire form (FS-6300-27) required by the USDA Forest Service for federal contract solicitations, referenced under FSH 6309.31 and 41 USC 1.

The form is designed to assess contractor capability and past performance across multiple dimensions. Contractors must provide basic information including company name, address, UEI number, and business structure (company, corporation, co-partnership, individual, or non-profit organization). The questionnaire requires disclosure of years of experience in the relevant line of work and contracting history as both prime and sub-contractors. Contractors must list all 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 running parallel to the proposed work, including contract numbers, dollar amounts, percentage completion, and expected completion dates. The form includes questions regarding any failure to complete awarded work or situations where performance bonds were required, with space to explain circumstances.

The form also evaluates organizational capacity and key personnel qualifications. Contractors must specify minimum and maximum employee availability, confirm whether employees are on regular payroll, and provide estimated minimum and maximum progress rates for the work. A section requires listing principal individuals with their present positions, years of experience, and the magnitude and type of work they have managed. Contractors must provide a comprehensive list of equipment and vehicles planned for use, including detailed descriptions and maintenance plans. Finally, contractors must describe their quality control and inspection procedures, safety plans, work schedule, and any bio-based products or materials to be utilized. The form requires certification by an authorized official with signature and date.

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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

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