J4 - Experience Evaluation Questionnaire.pdf

EXPERIENCE QUESTIONNAIRE

See Box 11, remarks, if extra space is needed to answer any item below or attach additional pages as necessary.

1. Contractors Name, Address & Telephone No.

2. Type of Business ____Company ____Co-Partner ____Non-profit ____Corporation ____Individual

3. How many years experience do you have in this line of work?

Trail Assessment ______yrs Optimal Trail Layout _______yrs Trail Field Data Collection______yrs

Program Management/Facilitation _______yrs Mechanized Trail Maintenance/Construction _______yrs

Education/Training _______yrs

3b. Which types of trails have you worked on in the past and how would you rate your experience working on these trails in each of the 5 categories of activities? Rate yourself with E-Excellent, A –Average, M- Minimal, N-No experience:

Trail maintenance

Trail construction

Operational planning, trails assessment, and optimal trail system location

Project management and faciliation

Training

Horse trails

Hiking trails

Mountain bike trails

Motorcycle trails

Off highway vehicle trails

Multi-use trails

Wilderness trails

Trail bridges

Blasting with explosives

3c. If bidding on the Education/Training service item, please submit A) courses you teach (titles, summary of courses) from training sessions you have administered, B) give two references from agency/organizations for whom you have put on training.

3d. Have you worked on projects with the USDA Forest Service or other federal or state government agency? _____Y/N If yes, please list the specific National Forest/Park or State Forest/Park or other agency.

4. How many years experience as a prime contractor_____ subcontractor___

5. List the projects your business has completed in the last 5 years. Submit a portfolio with details, photos, and references of 1 job completed within the last 5 years for maintenance or construction/reconstruction project. If bidding on Trail Assessment, design and layout, field data collection or program management, please attach a summary of work accomplished and an example sufficient to give reviewers an idea of your work.. Attach other pages if necessary

CONTRACT

NUMBER

AWARD

AMOUNT

NAME ADDRESS & PHONE

NO. TO CONTACT FOR INFO.

PERCENT

COMPLETED

DATE CONTRACT

COMPLETED

6. List all of your firm’s current contract commitments

CONTRACT

NUMBER

AWARD

AMOUNT

NAME ADDRESS & PHONE NO. TO CONTACT

FOR INFO.

PERCENT

COMPLETED

7a. Have you ever failed to complete any work awarded to you? __yes __ no 7b. Has work ever been completed by performance bond? __yes __ no

7. If "yes" to either item 7a or 7b specify location(s) and reason(s) why

8. Organization that will be availble for this project:

a. Minimum No. of employees: and Maximum No. of employees:

b. Number of employees regularly on your payroll: ______

c. Specify equipment available for this contract:

d. Estimate years of experience with the following:

Mini-excavators___yrs Mini-trail dozers____yrs Mini crawler carriers____yrs

Other trail machines(please list)___________yrs Hand crew management ______yrs Helicopter support ________ yrs

GPS/GIS_______yrs

Specialized Skills (please list)________________________

9. List the experience of the principal individuals of your business

INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK

10. Any additional certifications of employees (chainsaw, wilderness first aid, etc)?

11. REMARKS

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:

Name:

Title: Date: