Past Performance Experience Questionnaire.pdf
PDF 108 KB Posted
- Solicitation number
- 127EAT21Q0032
- Issued by
-
Department of Agriculture Forest Service
About this file
This solicitation requests proposals for janitorial cleaning services for restrooms located within the Descanso Ranger District. Offerors must provide all equipment, labor, supplies, transportation, and incidentals necessary to perform toilet cleaning services and removal of refuse from restrooms. The government is responsible for facility maintenance and vault pumping. Proposals are due no later than August 11, 2021 by 3:00 PM Pacific Time and must be emailed to citlalitl.leon@usda.gov. The solicitation is set aside for small businesses with a NAICS code of 561720 and size standard of $16.5 million. The Department of Agriculture Forest Service is the contracting agency.
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| 1036081 Maps Developed Recreation Site Locations.docx | DOCX document | |
| Wage Determination San Diego County.pdf | ||
| Descanso Recreation Site Cleaning SOW and Specs_2021(3).docx | DOCX document |
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Text version
EXPERIENCE QUESTIONNAIRE
1. CONTRACTOR NAME, ADDRESS AMD PHONE#
2. SUBMITTED TO (Office Name & 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 IN CONTRACTING HAVE YOU OR YOUR FIRM HAD AS A:
PRIME CONTRACTOR_________________ AND/OR 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,&PHONE OF OWNER/PERSON TO
CONTACT FOR PROJECT INFORMATION
7. LIST BELOW ALL OF YOUR CONTRACTUAL COMMITMENTS RUNNING CONCURRENTLY WITH THE
WORK CONTEMPLATED BY THIS PROJECT:
CONTRACT
NUMBER
AMOUNT
OF
AWARD
NAME, ADDRESS & PHONE # OF BUSINESS/GOVERNMENT
AGENCY INVOLVED
AWARDED
(UNITS)
PERCENT
COMPLETED
DATE
COMPLETED
_____NO
_____NO
8a. HAVE YOU EVER FAILED TO COMPLETE ANY WORK AWARDED TO YOU? ______YES 8b. HAS WORK EVER BEEN COMPLETED BY PERFORMANCE BOND? ______YES 8c. IF “YES” TO EITHER ITEMS SPECIFY LOCATION(S) AND REASON(S)WHY:
EXPERIENCE QUESTIONNAIRE PAGE 2
9. ORGANIZATION AND WORKERS THAT WILL BE AVAILABLE FOR THIS PROJECT:
a. MINIMUM NUMBER OF EMPLOYEES:___________ AND 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):
MINIMUM PROGRESS RATE:______________________ AND MAXIMUM PROGRESS RATE:_________________
10. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR BUSINESS:
INDIVIDUAL’S NAME
PRESENT
POSITION
YEARS
OF EXP. MAGNITUDE AND TYPE OF WORK
11. REMARKS: SPECIFY BOX NUMBERS (Attach sheets if extra space is needed to fully answer any of the above questions):
12a. CERTIFYING OFFICIAL’S NAME AND
TITLE
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. 12b. SIGNATURE 13.
DATE
AMOUNT
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