Experience Questionnaire.pdf
PDF 90 KB Posted
- Solicitation number
- 1240LT25Q0055
- Issued by
-
Department of Agriculture Forest Service
About this file
The document is a USDA Forest Service Experience Questionnaire, a standard form designed to capture a contractor's qualifications and background for a potential contract opportunity. The two-page form requires detailed information about the contractor's business, including years of experience in the relevant work, past project history, organizational capacity, available employees and equipment, and key personnel experience. Contractors must provide information on completed projects within the last three years, disclose any failed contract completions or performance bond usage, specify minimum and maximum employee numbers, and list the experience of principal business individuals. The form concludes with a certification section where the contractor's official must sign and affirm the accuracy of the provided information, authorizing the Forest Service to verify the company's capability to perform the project.
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Text version
USDA Forest Service (1/00)
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 10, 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) 3. Business Company Co-Partnership Corporation Individual Non-profit Organization
4. How many years do you or your firm have in the line of work contemplated by this solicitation? __________
5. How many years experience in contracting 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 (or currently working) where we can confirm that your company has experience in similar work.
Contract Amount
Type of Project Ongoing or
Date Completed
Name, Address, and Telephone No.
of Owner/Person to Contract for
Project Information
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 specify location(s) and reason(s) why:
8. Organization and work that will be available for this project:
a. (1) Minimum number of employees:__________ and a (2) Maximum number of employees:__________
b. Are employees regularly on your payroll? _____ Yes _____ No
c. Specify equipment available for this contract
9. List below the experience of the principal individuals of your business:
Individual’s Name
And City of Residence Present Position Years of
Exp.
Magnitude and Type of Work
10. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):
11. 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
12b. Signature (Sign in Ink) 13. Date
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