Exp_Questionaire.doc

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Brushy Forks, Lochsa-Powell RD, Nez Pece Clearwater NF
Solicitation number
12034318Q0198
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Amended Experience Questionnaire Form

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9. Submit the following for the Brushy Forks Section 8 Road Decommissioning project:

a. Plan of Operations (On separate sheet of paper)

b. Key Personnel

Use a separate sheet of paper if necessary.

10. List below the experience of the principal individuals expected to work on this project:

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 above questions):

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

12b. Signature (Sign in Ink)
13. Date

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