Experience_Questionaire_Sol.docx
DOCX document 18 KB Posted
- Attached to
- Tonto Cave Creek Refuse Collection Federal contract opportunity
- Solicitation number
- 127EAU24Q0029
- Issued by
- Department of Agriculture Forest Service
About this file
This experience questionnaire is for a refuse collection contract on the Cave Creek Ranger District of the Tonto National Forest. The contractor will provide all labor, equipment, supplies, services, permits and licenses necessary to collect, load, haul and dump refuse at recreation and administrative sites. The questionnaire requests information on the contractor's experience and qualifications, including years in business, prior contracts as prime or subcontractor, current contractual commitments, safety record, available employees and equipment, and experience of personnel to be assigned. It must be certified by an official of the contractor that the statements are complete and correct.
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Text version
USDA Forest Service
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, Remarks, if extra space is needed to answer any item below. Mark “X” in appropriate boxes.
1. Contractor Name, Address, and Telephone Number
2. Submitted to (Office Name and Address)
USDA Forest Service Mt Hood National Forest 16400 Champion Way Sandy, Oregon 97055
3. Business [ ] Company [ ] Corporation [ ] Non-profit Organization [ ] Co-partnership [ ] Individual
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. How many years experience 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 |
| 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 Amount |
Of Award
| Name, Address, and Telephone No. of Business/Government Agency Involved |
| Awarded |
(Units) Percent Completed Date Contract Complete
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. did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:
EXPERIENCE QUESTIONNAIRE, CONTINUED
9. Employees and equipment that will be available for this project:
a. (1) Minimum number of employees: _______ and (2) Maximum number of employees: _______
b. Are employees regularly on your payroll: [ ] Yes [ ] No
c. Specify equipment available for this contract: ______________________________________________________________________
d. 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 Personnel to work on this contract.
| Individual’s Name |
| Present Position |
| Years of Experience |
| Magnitude and Type of Work |
11. Remarks – Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT.
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.
12a. CERTIFYING OFFICIAL’S NAME AND TITLE
| b. SIGNATURE (Sign in blue ink) |
| 13. DATE |
File details come from the government source that posted it. Updated .