J.4 Experience Questionnaire (3 Pages) Pagosa Ranger Station Sewer Line Repairs.docx
DOCX document 29 KB Posted
- Attached to
- Pagosa Ranger Station Sewer Line Repair
- Solicitation number
- 1240LT23Q0093
About this file
This document is an experience questionnaire for contractors interested in the Pagosa Ranger Station Sewer Line Repair project. The questionnaire requests information on the contractor's experience, past projects completed, current commitments, personnel, equipment, and use of biobased products. It seeks details such as the number of years in relevant work, as prime and subcontractor, a list of completed projects in the last three years with owners as references, current contractual commitments and progress, bonding history, personnel experience, and equipment available for the project. The related federal contract opportunity is solicitation number 1240LT23Q0093 from the USDA Forest Service Rocky Mountain Region for sewer line repairs at the Pagosa Ranger Station. Contractors must complete and certify the experience questionnaire to be considered for the award.
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Text version
Solicitation
No:
1240LT23Q0093
Pagosa Ranger Station Sewer Line Repair San Juan National Forest
J.4 Experience Questionnaire
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) | ||
| 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 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 Amt. 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:
Solicitation
No:
1240LT23Q00
Pagosa Ranger Station Sewer Line Repair San Juan National Forest
Page
EXPERIENCE
QUESTIONNAIRE
CONTINUED
Employees and equipment that will be available for this project:
(1)
Minimum number of employees:
and (2) Maximum number of employees:
Are employees regularly on your payroll:
Yes
No Specify equipment available for this contract:
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: (Who will directly be involved in 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 ink) |
| 13. DATE |
Page 3 EXPERIENCE QUESTIONNAIRE CONTINUED
The following is added:
Biobased
Products Offeror shall identify the biobased products to be purchased and used under this contract.
For each biobased product, specify the name of the manufacturer, cost of each product, and the intended use of each of the materials that are to be used in carrying out the requirements of the contract.
For each biobased product, the Offeror shall specify the percentage of biobased content, and for the USDA-designated biobased content products, the Offeror shall demonstrate that the products to be used under this contract will contain the percentage specified in the USDA recommendations or the highest level of biobased material practicable, consistent with USDA's recommended percentages of biobased content.
The Offeror shall document prior experience in specifying, purchasing, using, and installing biobased products.
The Offeror shall provide a list of all relevant contracts over the past 3 years involving the specification, purchase, and/or use of biobased products.
The Offeror shall include a list of the biobased products specified, purchased, used, and installed.
The above information shall be provided for all proposed subcontractors in the same format and level of detail as prescribed for the Offeror.
Attach additional sheets, as necessary.
File details come from the government source that posted it. Updated .