Experience Questionaire.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 Forest Service Mt Hood National Forest 16400 Champion Way Sandy, Oregon 97055

3. Business [ ] Company [ ] Corporation [ ] Non-profit Organization [ ] Co-partnership [ ] Individual

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:

Contract Amount

Owner/Person to Contact for Project Information

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

Of Award

(Units) Percent Completed Date Contract Complete

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

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. Specify equipment available for this contract: ______________________________________________________________________

10. List below the experience of the Personnel to work on this contract.

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.

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