EXPERIENCE QUESTIONNAIRE.docx
DOCX document 15 KB Posted
- Attached to
- Ironton RD Custodial Services, Pedro, OH Federal contract opportunity
- Solicitation number
- 1252B120Q0010
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 2.15 QASP.docx | DOCX document | |
| 2.3 Location Maps.pdf | ||
| quote doc and clauses.pdf | ||
| 2.1 IRD Office_Floorplan.pdf | ||
| wage determination.pdf |
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EXPERIENCE QUESTIONNAIRE
Instructions: Use Box 10 Remarks if extra space is needed to answer any item below. Answer all items.
1. Contractor’s Name, Address & Telephone #.
2. 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? ____
5. List the projects your business has completed in the last three (3) years.
| CONTRACT AMOUNT |
| TYPE OF CONTRACT |
| DATE COMPLETED |
| Contact Name, Address and Tele. # |
6. List all of your firms’ current contract commitments
| CONTRACT NUMBER |
| AWARD AMOUNT |
| Contact Name, Address & Tele. # |
| 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 |
c. Specify equipment available for this contract:
d. Estimate rate of progress (exp. 100 feet, 1/8 mile a day, etc…):
Minimum progress rate:____________ Maximum progress rate:____________
9. List the experience of the principal individuals of your business
| NAME |
| PRESENT POSITION |
| YRS EXP. |
| TYPE OF WORK |
10. REMARKS
TIN#__________________ Duns#_______________ 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 |
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