Experience Questionnaire_1284LL22Q0017.docx

Combined Synopsis No.: 1284LL22Q0017 / CdA Nursery Tree Cold Storage Maintenance – Idaho Panhandle N.F.

Experience Questionnaire / Page 1 of 6

USDA Forest Service (3/03)

9.0. 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 & Address)

Idaho Panhandle National Forest Attn: 1284LL22Q0017 3232 West Nursery Road Coeur d’Alene, ID 83815

Email this with Quote to: darrin.jackson@usda.gov

3. Business

· Company Partnership

· Corporation Individual

· Non-profit Organization

4. How many years do you or your firm have in the line of work relevant to the requirement for this solicitation? (Refrigeration, AG cooling systems for Ammonia systems)

5. How many years of experience in Government and Commercial contracting have you or your business has for the following:

(a) Prime Contractor (Government): ________ (c) Prime Contractor (Commercial): ________

(b) Sub-Contractor (Government): ________ (d) Sub-Contractor (Commercial): ________

6. List below the projects your business has completed within the last 3 years over $25,000.00 (Relevant to this solicitation):

Contract Amount

Completed Name, Address, and Telephone No. of Owner/Person to Contract for Project Information

7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation (if applicable):

Contract Amount Dollar Amt Of Award

(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:

9. Contractor Technical Capability/Past Performance Information.

The offeror technical capability information shall address the evaluation factors (see FAR 52.212-2). The technical information shall include the minimum, but not limited to the following:

Provide a list of similar projects completed by your firm over the past three (3) years. Provide a brief description of the project description, dollar value, contract number (if applicable), and the project owner with contact information (Name, Phone, and Email). – See page 3 for form.

The offeror shall provide a brief description/work plan for their approach for this requirement providing the following, but not limited to:

a) Provide a list of Key Personnel (with qualifications/certifications) with years of experience that will be used for this project. List certifications that you currently hold for Anhydrous Ammonia.

b) List any relevant experience for work on AG cooling systems for ammonia cooler systems.

c) Provide a brief description of the parts/equipment with offer (include brand, model number, manufacturer part number or wholesaler number, and item description, etc.).

d) Submit the estimated start and completion for this project.

e) Describe your experience working on refrigeration systems for cold storage of produce and other perishable commodities.

f) List your experience installing and programming Variable Frequency Drives (VFDs) for operating various components in a cold storage system.

g) List what operating systems are you experienced routinely working with when servicing cold storage systems and working with Anhydrous Ammonia systems.

May submit separate form/document, but must address and answer all questions (a-g).

10. List below the experience of the key individuals of your business for this project:

Individual’s Name (Key Personnel)

11. Remarks - Specify Box Numbers (May attach sheets if extra space is needed to fully answer any above questions):

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. Contractor Certifying Official’s Name and Title:

12b. Contractor Signature (Ink Signature or E-Signature):

12c. Date

Combined Synopsis No.: 1284LL22Q0017 / Coeur d’Alene Nursery Tree Cold Storage Maintenance – Idaho Panhandle N.F.

Experience Questionnaire / Page 1 of 2

PAST PERFORMANCE INFORMATION

NOTE: You may submit this information on your own forms in any format as long as all the information listed on this form is provided. List all contracts or subcontracts over $25,000 in value you have been involved with in the past three (3) years. You may also include projects over three years old which are directly applicable to the type of work required by this solicitation.

MAY USE THIS FORM TO FILL OUT THE FOLLOWING INFORMATION:

Contracting Activity

Contract No

Contract Type

Contract Amount

Completion Date

Type of Work

Contracting Officer

NAME:

PHONE:

EMAIL:

NAME:

PHONE:

EMAIL:

NAME:

PHONE:

EMAIL:

COR

Representative

NAME:

PHONE:

EMAIL:

NAME:

PHONE:

EMAIL:

NAME:

PHONE:

EMAIL:

Major Sub-Contractors

BUSINESS &

CONTACT:

PHONE:

BUSINESS &

CONTACT:

PHONE:

BUSINESS &

CONTACT:

PHONE:

***Please make blank photo copies of this page if you need additional space to include all appropriate past performance jobs.***