J16-MATOC FM and S Roads Experience Questionnaire.pdf
PDF 169 KB Posted
- Solicitation number
- 12445224B0007
- Issued by
-
Department of Agriculture Forest Service
About this file
This document is an Experience Questionnaire for a federal contract opportunity titled "Francis Marion & Sumter National Forests Roads Maintenance, Repairs & Construction IDIQ." The questionnaire requests information about the contractor's business, including years of experience, current/past relevant projects, contract management capabilities, and small business subcontracting efforts. It also requires financial information to determine the contractor's responsibility.
The related federal contract opportunity is a Multiple Award Task Order Contract (IDIQ) for the maintenance, repair, and construction of roads within the Francis Marion and Sumter National Forests in South Carolina. The contract has a ceiling of $10,000,000 and is a 100% Total Small Business Set-Aside. The primary NAICS code is 237310 Highway, Street, and Bridge Construction. The Government intends to award multiple contracts to up to eight (8) contractors, with task orders awarded to the lowest cost responsive proposal. The Request for Proposal (RFP) is due on June 7, 2024, and site visits will be held on May 14-16, 2024.
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Text version
Attachment 8
ATTACHMENT D
EXPERIENCE QUESTIONNAIRE
Instructions: See Item No. 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
1. Contractors Name, Address & Telephone No.
e-mail:
2. Type of Business
__Company __Co-Partner
__Corporation __Individual
__Non-profit
DUNS No. _____________________________
Taxpayer ID No.
3. How many years experience do you have in this line of work? ____Yrs
4. How many years experience as a prime contractor? _____ Subcontractor? ___
5. List the relevant current/past projects for your business in the last 3 years:
a. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
Name, Address & Telephone Number for Point of Contact for Information:
b. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
c. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
d. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
e. Project (Location): ____________________________________________________________________________________
Contract Amount $______________________________________ Period of Performance______________________________
Description of Services (i.e. type of trail, length of trail, equipment used, tasks performed, trades involved)
Attach supplemental sheets if space above is not sufficient
6. Have you ever failed to complete any work awarded to you? __yes __ no. If yes, specify location(s) and reason(s) why.
7. Contract Management:
a. No. of employees: b. Are employees regularly on your payroll: __yes __ no
c. Specify contractor owned equipment (indicate size & capacity) to be used for this contract
d. Tasks to be subcontracted:
e. Provisions to secure additional equipment or personnel:
f. Past experience in managing multiple contracts simultaneously:
(ADDITIONAL SHEETS MAY BE ATTACHED TO SUPPLEMENT THIS FORM)
8. Small Business Subcontracting Efforts (List proposed subcontractors to be used on the contract and indicate the type of business (i.e. Small Business, Women Owned, Small Disadvantaged)
9. List the experience of the principal individuals of your business
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
10. Information required to complete a financial responsibility determination of the apparent successful offeror.
a. Credit References
Company Name/Address Point of Contact Telephone number TYPE OF WORK
b. Banking Information.
Company Name/Address Point of Contact Telephone number TYPE OF WORK
11. REMARKS: (PLEASE NOTE ADDITIONAL SHEETS MAY BE ATTACEHD TO SUPPLEMENT THIS FORM)
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:
Name:
Title: Date:
File details come from the government source that posted it. Updated .