J.4 - Contractor Experience Questionaire.docx
DOCX document 18 KB Posted
- Attached to
- Virginia Lakes Restroom Repair (GAOA)
- Solicitation number
- 1240LT24R0010
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is an Experience Questionnaire for a federal contract opportunity. It requests information from the contractor regarding their company, experience, employees, equipment, and past performance.
The related federal contract opportunity is for the repair and renovation of a double vault restroom and associated ADA facilities at Virginia Lakes in the Humboldt-Toiyabe National Forest. The project involves tasks such as replacing roof flashing and shingles, doors and hardware, manhole covers, and constructing ADA parking and a concrete pathway. The contract is a firm-fixed-price, total small business set-aside with a project value between $25,000 and $50,000. Key dates include a site visit on July 11, contractor questions due by July 17, and the proposal due date of July 24, 2024. The contracting officer for this opportunity is Elizabeth Ratcliff.
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Text version
USDA Forest Service
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 and Address) U.S Forest Service (USDA) 324 25th Street Ogden, Utah 84401-2310
3. Business [ ] Company [ ] Corporation [ ] Non-profit Organization [ ] Co-partnership [ ] Individual
4. How many years do you or your firm have in the line of work contemplated by this solicitation?
5. How many years experience 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
| Type of Project |
| Date Completed |
| Name, Address, and Telephone No. of |
Owner/Person to Contact for Project Information
7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:
| Contract Number |
| Dollar Amount |
Of Award
| Name, Address, and Telephone No. of Business/Government Agency Involved |
| Awarded |
(Units) Percent Completed Date Contract Complete
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. did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:
EXPERIENCE QUESTIONNAIRE, CONTINUED
9. Employees and equipment that will be available for this project:
a. (1) Minimum number of employees: _______ and (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 Personnel to work on this contract.
| Individual’s Name |
| Present Position |
| Years of Experience |
| Magnitude and Type of Work |
11. Remarks – Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question):
NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT.
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
| b. SIGNATURE (Sign in blue ink) |
| 13. DATE |
File details come from the government source that posted it. Updated .