Attachment_03__Experience_Questionnaie.docx

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Attached to
Janitorial Services Federal contract opportunity
Solicitation number
12456818R0020
Issued by
Department of Agriculture Forest Service Research Service Southern Research Station

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Attachment 03 Experience Questionnaire

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SF_1449_RFP_12456818R0020.pdf PDF
Solicitation_Body_12456818R0020.doc DOC document
Attachment_01_SCA_Wages.docx DOCX document
Attachment_02_Statement_of_Work.pdf PDF
Attachment_00_Frequency_Schedule_for_all_Buildings.pdf PDF

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12456818R0020

SRS

Janitorial Services

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

1. Contractors Name, Address & Telephone No. Email
2. Type of Business
CompanyCo-Partner Non-profit

Corporation Individual

3. How many years of experience do you have in this line of workYrs
4. How many years of experience as a prime contractorsubcontractor

5. List no more than 5 most relevant projects your business has performed within 3 years of this solicitation issuance date:

CONTRACT

NUMBER

AWARD

AMOUNT

NAME, ADDRESS, E-MAIL, & PHONE NO. TO CONTACT FOR INFORMATION.
DATE

CONTRACT

COMPLETED

DESCRIPTION OF WORK PERFORMED

6. List all of your firms current contract commitments CONTRACTPERCENT COMPLETED

NAME, ADDRESS, E-MAIL, & PHONE NO. TO CONTACT FOR INFORMATION.

AWARD AMOUNT

NUMBER

7a. Have you ever failed to complete any work awarded to you?yesno
7b. Has work ever been completed by performance bond?yesno

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

8. Organization information available for this project:

a. Minimum # of employees: and Maximum # of employees:

b. Are employees regularly on your payroll: yes no

c. Specify equipment available for this contract:

d. Estimate rate of progress (such as 2.0 acres per day):

1. Minimum progress rate: Maximum progress rate

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

INDIVIDUALS NAME
PRESENT POSITION
YRS EXP
TYPE OF WORK

10. Information required to complete a responsibility determination if the apparent successful offeror.

a. Credit References

Company Name/Address
Point of Contact
Telephone number
TYPE OF WORK

b. Banking Information.

Company Name/Address
Point of Contact
Telephone number
TYPE OF WORK

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:

Attachment 03

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