Experience_Questionnaire.xls

XLS spreadsheet 37 KB Posted

Attached to
Duncan House Roof Replacement
Solicitation number
140P6426Q0012
Issued by

About this file

This is an Experience Questionnaire form required for the Duncan House Roof Replacement project solicitation (140P6426Q0012) issued by the National Park Service for Cuyahoga Valley National Park in Brecksville, Ohio. The form serves as a template for small business contractors to demonstrate their qualifications and capability to perform the work.

The questionnaire requires contractors to provide comprehensive business and experience information, including company type and registration details (SAM DUNS number), years of experience in the line of work and as a prime contractor, and a detailed list of projects completed within the past three years with contract amounts, project types, completion dates, and reference contacts. Contractors must also disclose current contract commitments, any history of incomplete work or performance bond requirements, and specify the organization's capacity including minimum and maximum employee availability, payroll status, and equipment resources. The form requires documentation of principal individuals' qualifications and certifications, financial responsibility verification through either a financial institution letter or direct submission of account status information, and certification that the contractor intends to complete the project as specified and conform to all solicitation requirements. The form includes a remarks section for additional information and must be signed by an authorized representative with title and date.

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Text version

Sheet1

1. Contractors Name, Address, & Telephone No.:2. Type of Business
Name:
Address:Company
Corporation
Non-profit Org
Telephone No.:Co-partner
SAM DUNS No:Individual
3. How many years experience do you have in this line of work?Years
4. How many years experience as a prime contractor?Years
5. List the projects your business has completed in the last 3 years:
CONTRACT
AMOUNTTYPE OF
PROJECTDATE
COMPLETEDNAME, ADDRESS & TELEPHONE NO.TO

CONTACT FOR INFORMATION

6. List all of your firms current contract commitments:
CONTRACT
NUMBERAWARD
AMOUNTNAME, ADDRESS, & PHONE NO.
TO CONTACT FOR INFORMATIONPERCENT
COMPLETEDDATE

COMPLETED

7a. Have you ever failed to complete any work awarded to you?YesNo
7b. Has work ever been completed by performance bond?YesNo
7c. If "Yes" to either item 7a or 7b, specify locations and reason why:
8. Organization that will be available for this project:
a. Minimum No. of employees:and maximum No. of employees:
b. Are employees regularly on your payroll?YesNo
c. Specify equipment available for this project:
9. List the experience of principal individuals with proper qualifications/certifications to be used on this project:
INDIVIDUALS
NAMEPRESENT
POSITIONYEARS
EXPERIENCETYPE OF WORK
10. Financial Responsibility:
(in lieu of this, you may submit a letter from your
financial institution that addresses the status and standing of your accounts)
Name of Financial Institution
Address:
Contact Name
Contact Phone Nbr
11. Remarks
CERTIFICATION: I certify that I intend to complete the project as specified and that my offer conforms to the specifications of the solicitation without deviation unless I provide an alternative proposal. All 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 National Park Service with any information needed to verify my capability to perform this project.
SIGNATURETITLEDATE

EXPERIENCE QUESTIONNAIRE

Instructions: This form may be completed manually or by using MS Excel. See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

File details come from the government source that posted it. Updated .