Attachment_4_Experience_and_Past_Performance_Questionnaire.docx
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- Attached to
- Mowing Wildlife Forage Areas and Recreation Fields Cherokee National Forest (Ocoee Ranger District)
- Solicitation number
- 12475619Q0008
- Issued by
-
Department of Agriculture Forest Service
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Questionnaire
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| File | Type | Posted |
|---|---|---|
| 12475619Q0008.pdf | ||
| Ocoee_Openings_Map_for_Contract.pdf |
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Solicitation No. 12475619Q0006 Attachment 4
EXPERIENCE AND PAST PERFORMANCE QUESTIONNAIRE
Instructions: Use Item No. 10 Remarks if extra space is needed to answer any item below. Answer all items.
1. Contractor’s Name, Address & Telephone Number.
1. Type of Business
___Company ___Co-Partner ___Corporation ___Individual ___Non-profit Organization
| 3. How many years’ experience do you have in this Line of work? ____ Years |
| 4. How many years’ experience as a Prime Contractor? _____ Years |
Subcontractor? _____ Years
5. List the projects your business has completed in the last three (3) years.
| COMPANY NAME, ADDRESS , TELEPHONE NUMBER AND CONTACT PERSON |
| CONTRACT TYPE/PROJECT DESCRIPTION |
| CONTRACT AMOUNT |
| PERIOD OF PERFORMANCE/DATE COMPLETED |
1. List all of your firms’ current contract commitments.
| CONTRACT NUMBER |
| AWARD AMOUNT |
| Contact Name, Address & Telephone Number |
| Percent Completed |
| Date Contract 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
7c. If “Yes” to either item 7a or 7b above, specify reason(s) and location(s) why.
8. Organization structure that will be available for this project:
| a. Minimum No. of employees: _____ | and Maximum No. of employees: _____ | ||
| b. Are employees regularly on your payroll? | ___Yes | ___No |
1. Specify equipment available for this contract:
9. List the experience of the principal individuals of your business
| NAME |
| PRESENT POSITION |
| YEARS EXPERIENCE |
| TYPE OF WORK |
10. REMARKS
CERTIFICATION: I certify that all of the statements made by me are complete and correct to be 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.
| __________________________ | ___________________________ | ___________________ | ______ | ||
| Signature | Print or Typed Name | Title | Date |
Duns # _______________
Tax ID# ______________
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