ExperienceQuestEastForkPipeCrkBridge.docx

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)

USDA FS, IPNF, AQM

3815 Schreiber Way Coeur d Alene, ID 83815

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. Past Performance: List below the projects using the format below, your business has completed within the last three years, 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… previously provided to you. You may use a separate sheet of paper.

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

8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No 8b. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8c. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:

EXPERIENCE QUESTIONNAIRE CONTINUED

9a. Technical:

i) Identify Key Personnel by name per Section H and list their skills/qualifications for the positions held.

ii) Plan of Operation. Provide understanding of project including time flow chart with major milestones. Show expected completion of project in 2019 or 2020.

9b. Experience: Identify other relevant projects similar in size and scope of this project your firm has accomplished in the past three years. These may be the same as identified under Past Performance.

10. List below the principal individuals of your business:

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

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT.

Attach additional sheets, as necessary.

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