FS 6300-27_Experience Questionnaire.pdf
PDF 144 KB Posted
- Solicitation number
- 12970224Q0059
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is an Experience Questionnaire (FS-6300-27) that is part of a federal contract solicitation for the provision of commercial services to replace refrigeration equipment for two walk-in freezers at the Trapper Creek Jobs Corps Civilian Conservation Center.
The key details are:
- The solicitation number is 12970224Q0059 and the contract opportunity is to remove existing evaporator and condensing units and install new ones, hooking them up to the existing electrical service.
- The contracting agency is the Department of Agriculture Forest Service.
- The questionnaire asks for information about the contractor's experience, including years in the line of work, project history, concurrent commitments, equipment and personnel resources, and quality control procedures.
- Contractors must provide details on their capabilities to meet the requirements, such as minimum/maximum number of employees, equipment availability, and anticipated progress rates.
- The contractor must certify that the information provided is complete and accurate.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Trapper Creek Freezer-SOI.pdf | ||
| SOL 12970224Q0059.pdf | ||
| TCJC Bldg15 Maps and Floorplan.pdf | ||
| Trapper Creek Freezer-SOW-signed.pdf | ||
| Wage Determination 2015-5401 Rev 23.pdf |
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Text version
United States Department of Agriculture
Forest Service
SPOC SW
Contract Service
Trapper Creek Job Corp Center Darby, MT
Previous edition is obsolete Page 1 of 3 FS-6300-27 (3/00)
USDA – Forest Service
EXPERIENCE QUESTIONNAIRE
(Ref. FSH 6309.31 and 41 USC 1)
INSTRUCTIONS: See Box 11, Remarks, if extra space is needed to answer any questions below. Mark “X” in appropriate boxes.
1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NO.
2. SUBMITTED TO (office Name and Address)
USDA Forest Service Attn: Jacob Pipkin, Contract Specialist
Email: jacob.pipkin@usda.gov
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 of 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:
CONTRACT
AMOUNT
(6a)
TYPE OF PROJECT AND BRIEF DESCRIPTION
(6b)
DATE
COMPLETED
(6c)
NAME, ADDRESS, AND TELEPHONE NO. OF
OWNER/PERSON TO CONTACT FOR PROJECT
INFORMATION
(6d)
Agriculture
Forest Service
SPOC SW
Contract Service
Trapper Creek Job
Previous edition is obsolete Page 2 of 3 FS-6300-27 (3/00)
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
CONTRACT
NUMBER
(7a)
DOLLAR AMT.
OF AWARD
(7b)
NAME, ADDRESS, AND TELEPHONE NO. OF
BUSINESS/GOVERNMENT AGENCY INVOLVED
(7c)
AWARDED
(Date) (7d)
PERCENT
COMPLETED
(7e)
ANTICIPATED
COMPLETE DATE
(7f)
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: Yes No 8d. Did you look at the project site(s) on-the-ground? Yes No
9. 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: __________________________________________________________________________
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 principal individuals of your business:
INDIVIDUAL’S NAME
(10a)
PRESENT
POSITION
(10b)
YEARS
OF EXP.
(10c)
MAGNITUDE AND TYPE OF WORK
(10d)
11. List all the equipment you own or have available through a rental agreement to be used on this contract/agreement. Provide a detailed description of the Equipment including your maintenance and cleaning plans.
Agriculture
Forest Service
SPOC SW
Contract Service
Trapper Creek Job
Previous edition is obsolete Page 3 of 3 FS-6300-27 (3/00)
12. Contractor Inspection. Describe Contractor Self Inspection Procedures which you will use to insure quality for this contract.
13. Remarks. Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
CERTIFICATION
I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any person’s name as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
14a. CERTIFYING OFFICIAL’S NAME AND TITLE
14b. SIGNATURE (Sign in ink) 14c. DATE
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