Experience Questionaire.docx
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- Attached to
- Toilet Pumping for London Ranger District
- Solicitation number
- 12443925Q0006
- Issued by
-
Department of Agriculture Forest Service
About this file
This is an Experience Questionnaire form template that contractors must complete to demonstrate their capabilities and past performance for a toilet pumping services contract with the USDA Forest Service's Daniel Boone National Forest, London Ranger District.
The questionnaire requires contractors to provide basic business information, years of experience as prime/subcontractor, details of completed projects from the past 3 years, current contract commitments, organizational capacity (including number of employees and equipment), key personnel experience, credit references, and banking information. The form includes sections for contractors to specify their progress rates and explain any past performance issues like failed contracts or performance bond completions. This questionnaire will be used as part of the technical acceptability evaluation on a pass/fail basis for the toilet pumping services contract that has a base year (04/01/2025 - 03/31/2026) plus four option years through 2030.
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Text version
1. Contractors Name, Address & Telephone No. Email
2. Type of Business __Company __Co-Partner __Non-profit __Corporation __Individual
3. Howmany years experience do you have in this line of work____Yrs
4. How many years experience as a prime contractpr_____ subcontractor___
5. List the projects your business has completed in the last 3 years from the solicitation issuance date
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO. |
| PERCENT |
COMPLETED
DATE CONTRACT
COMPLETED
6. List all of your firms current contract commitments
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO. |
| PERCENT |
COMPLETED
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
7. If "yes" to either item 7a or 7b specify location(s) and reason(s) why
8. Organization information available for this project:
a. Minimum # of employees: and Maximum # of employees:
b. Are employees regularly on your payroll: __yes __ no
c. Specify equipment available for this contract:
d. Estimate rate of progress (such as 2.0 acres per day):
1. Minimum progress rate: Maximum progress rate
9. List the experience of the principal individuals of your business
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
10. Information required to complete a responsibility determination if the apparent successful offeror.
a. Credit References
| Company Name/Address |
| Point of Contact |
| Telephone number |
| TYPE OF WORK |
b. Banking Information.
| Company Name/Address |
| Point of Contact |
| Telephone number |
| TYPE OF WORK |
11. REMARKS
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:
Name:
| Title: |
| Date: |
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
Attachment 4
File details come from the government source that posted it. Updated .