J-2_Experience_Questionnaire.docx

RFQ No.: 12034319Q0010 / Auxor Road Reconstruction – Rd 489 / Idaho Panhandle National Forest Attachment J-2 Experience Questionnaire / Page 1 of 2

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:

7. List below all of your firm’s current contractual commitments running concurrently with the work contemplated by this solicitation (NOTE: PoP: 08/12/2019 – 10/15/2019)

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:

EXPERIENCE QUESTIONNAIRE CONTINUED

9. Employees and equipment that will be available for this project:

a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____

b. Are employees regularly on your payroll: [ ] Yes [ ] No

c. If you plan on Sub-Contracting, provide the name and contact information: ________________________________________________________________________________________________________________________________________________________________________________________________________________________

d. List your plan of operations to demonstrate understanding of the project and scope of work requested (include a timeline flow chart, resources/equipment for this project), may submit on separate document: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10. List below the experience of the principal individuals of your business. (Who will directly be involved in this contract?) *NOTE: Key Personnel and list their title and specific position for this work being requested.

11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):

NOTE: PROVIDE ANY ADDITIONAL INFORMATION THAT MAY BE BENEFICIAL FOR EVALUATION; MAY SUBMIT SEPERATELY FROM THIS DOCUMENT (May submit information on separate document, but must answer all questions on this form to be considered responsive).

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