QUESTIONNAIRE.doc

QUESTIONNAIRE

To expedite this preparation of this form, the Contractor may elect to fill it in by hand. If the is done, IT MUST BE LEGIBLE AND CLEARLY READABLE! Or the Contractor may recreate this form in a Desktop Word Processing application or refer to attachments for the requested information.

Background Information Current Company Name

Past Company Name(s) (if any) _________________________________________________________________

Current Business Address & Contact No.

Current Owner’s Name

Please list below the owner’s experience & qualifications, certifications held, number of years in this type of industry and any other pertinent information that you feel are beneficial to your company’s review:

1. Past Performance History

a) List below the projects completed by your business within the last five (5) years that most closely relate to this type of work. Provide other pertinent information for similar projects.

b) Have you failed to complete any project in the last five (5) years? [ ] Yes [ ] No

If “yes”, list all contracts not completed, provide explanation of the circumstances, remedy of situation, and action taken to avoid recurrence.

2. Experience of Firm, Key Personnel, and Sub-Contractors

a) Key personnel. List important personnel/subcontractors who will be working on this project. It is expected that any and all personnel listed on this form SHALL be actively involved in our project.

3. Capability to Perform

a) List below current project information.

b) Given existing workload, describe firm’s ability to complete this project work within the specified contract specifications:

4. Remarks/Additional Information

CERTIFICATION: I certify that all of the statements made above 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.

Signature Title Date Attached any additional information you feel is pertinent to the evaluation process of your company and/or employee(s) qualifications and capabilities.