Experience Questionaire.docx
DOCX document 22 KB Posted
- Solicitation number
- 12443925Q0016
- Issued by
-
Department of Agriculture Forest Service
About this file
The Experience Questionnaire is a detailed form for potential contractors to provide comprehensive information about their business capabilities and past performance for a toilet pumping services contract with the USDA Forest Service's Daniel Boone National Forest. The document requires vendors to disclose business type, years of experience, past project details, current contract commitments, organizational capacity, employee information, equipment availability, and key personnel experience. Contractors must demonstrate technical competence through the questionnaire, which serves as a pass/fail evaluation criteria for the solicitation.
The contract (Solicitation #12443925Q0016) is a small business set-aside for septic tank and related services, with a base year from 04/01/2025 - 03/31/2026 and four potential option years extending through 03/31/2030. The procurement is for toilet pumping services on the Stearns Ranger District, with a firm fixed-price purchase order anticipated. Eligible businesses must have $9.0M or less in average annual receipts, possess necessary equipment and personnel to access work sites, and maintain an active SAM registration. The award will be determined on a best value basis, with technical acceptability being a critical pass/fail evaluation conducted solely by the Contracting Officer.
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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 .