EXPERIENCE QUESTIONNAIRE.docx

DOCX document 18 KB Posted

Attached to
Indian-Celina Mowing Federal contract opportunity
Solicitation number
12363N25Q4013
Issued by
Department of Agriculture Forest Service

About this file

This is an experience questionnaire form that contractors must complete to demonstrate their qualifications for the Indian-Celina Mowing project at the Hoosier National Forest. The questionnaire requests detailed information about the contractor's business structure, years of experience as prime and subcontractor, similar completed projects from the past three years, current contract commitments, organizational capacity, and key personnel qualifications.

The form specifically requires contractors to document their experience with handheld GPS and Shapefile/Avenza systems, which aligns with the project requirement to use GPS for staying within designated boundary areas. Other key elements include listing available equipment, estimated progress rates, and verification of ability to maintain proper staffing levels. The form requires the contractor's TIN and DUNS numbers and must be signed to certify all information is complete and correct, with permission for the Forest Service to verify the contractor's capabilities through provided references.

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Text version

EXPERIENCE QUESTIONNAIRE

1. Contractor’s Name, Address & Telephone #.

2. Type of Business

___Company ___Co-Partner ___Corporation ___Individual ___Non-profit Organization

3. How many years experience do you have related to this line of work? _______ years
4. How many years experience as a prime contractor? ________years

Subcontractor? _______

5. List all the similar projects your business has completed in the last three (3) years.

CONTRACT AMOUNT
TYPE OF CONTRACT WORK
DATE COMPLETED
Contact Name, Address and Tele. #

6. List all of your firms’ current contract commitments

CONTRACT NUMBER
AWARD AMOUNT
Contact Name, Address & Tele. #
Percent Completed
Date Contract 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

7c. If “yes” to either item 7a or 7b above, specify reason(s) and location(s) why.

8. Organization structure that will be available for this project:

a. Minimum No. of employees: _____and Maximum No. of employees:_____
b. Are employees regularly on your payroll?___yes___no

c. Specify equipment to be used for this contract:

d. Estimate rate of progress (exp. 100 feet, 1/8 mile a day, etc…):

Progress Rate of _______________

9. List the experience of the principal individuals of your business tied to this project

NAME
PRESENT POSITION
YRS EXP.
TYPE OF WORK

10. Hand Held GPS and Shapefile experience, And/or Avenza Experience:

11. Work plan: Describe plan how to accomplish task.

TIN#__________________ Duns#_______________ CERTIFICATION: I certify that all of the statements made by me are complete and correct to be 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.

______________________________________________________________________________
SignaturePrint or Typed NameTitleDate

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