J-3_Experience_Questionnaire.docx

USDA Forest Service (3/03)

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 & Address)

R1 IMAT IPNF

3815 Schreiber Way Coeur d Alene, ID 83815

3. Business

· Company 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 business had as a (a) prime contractor ________ and/or

(b) sub-contractor ______?

6. Relevant Past Performance. List projects relevant to road decommissioning your business has completed within the last three years (use format below) OR you may provide previous customers with an attached Past Performance Survey to complete and submit OR submit copies of performance evaluations, letters of recommendation, etc… provided to you by previous customers.

(ii) Past Performance will be evaluated on the following:

Contract Amount

Type of Project and Location

Date Completed Name, Address, and Telephone No. of Owner/Person to Contract for Project Information

Complete on a separate Sheet of Paper in lieu of this block.

7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

Contract Amount Dollar Amt Of Award

(Units) Percent Completed Date Contract Completed

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. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why:

9. Technical:

a) Approach and Understanding Describe your plan to accomplish the work include the following:

i) equipment to be used, include Year, Make, Model, Size and attachments if applicable.

ii) proposed dates for each road, submit a timeline/flowchart with the sequence of work.

iii) Quality Control Plan, inspection procedures, See Section E of the solicitation package

iv) identify the number of springs/seeps, headwater swales, stream channel restorations, ditch relief culverts, etc… for each road.

b) Management

i) Identify Key Personnel by name, and their specific experience-skills-qualifications for the position identified, per Section H, AGAR 452.237-74, to complete this type of work, include references. Describe extent of work & type of terrain, such as full recontouring, outslope, drainage removal, entrance closures.

ii) Subcontractors

c) Did you visit the project sites?

d) Identify list of Bio-based products that will be used for this project. Reference Section I, FAR 52.223-2 Affirmative Procurement of Biobased Products Under Service and Construction Contracts.

NOTE: Relevant equates to same or similar work performed on rural- often remote networked-forest roads characterized by gravel or native material surfaces, narrow, curving, often shoulderless, adjacent to environmental sensitive streams or wetlands; having apurtenances such as signs, gates & culverts; steep drop-offs; often un-focused public drivers of vehicles including motorcycles, four-wheel ATV’s, recreational vehicles and industrial traffic. Decommissioning treatments initiate restoration of ecological processes interrupted or adversley affected by a road. Treatment results in permanent road closure.

Attach separate sheet(s) of paper for responses as necessary

10. List the principal individuals of your business:

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