Attachment_6-_Forest_Service_Experience_Questionnaire.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)

R1 AQM, IMAT, IPNF

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. Provide a list of 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: Use a separate sheet of paper as needed:

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

Specify Box Numbers (Attach sheets to fully answer any question.):

9 Technical:

A) Identify the Equipment Operator and his/her past three years of relevant experience/skill performing this specific type or work.

B) Identify the Equipment to be used for the project, include year, make and model

C) 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.

NOTE: NOTE: Relevant equates to same or similar work for constructing fireline or fuel breaks and slash piling on slopes of varying degree or percentages, wet and/or rocky terrrain normally performed in rural- often remote forested areas.

10. List below the experience of the principal individuals of your business and type of equipment that will be used: (Who will directly be involved in this contract?)

12. 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.

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