Experience_&_Capability_Questionnaire.pdf

Combined Synopsis/Solicitation 12569R18Q0026 J.W. Toumey Nursery Weeding

EXPERIENCE AND CAPABILITY QUESTIONNAIRE

Instructions: See Box 10, REMARKS. If extra space is needed to answer any items below. Mark "X" in the appropriate boxes.

Please list NA for inapplicable items.

1. Contractor's Name, Address & Telephone Number 2. Type of Business

____ Company

____ Corporation

____ Non‐profit Organization

____ Co‐partner

____ Individual

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

4. How many years of experience as a prime contractor? _________ subcontractor? ________

5. List the projects your business has completed in the last 3 years.

Contract Amount

Type of Project Date Completed

Name and Telephone Number to Contact For Information

6. List contractual commitments running concurrently with the work contemplated by this soliciation.

Contract Number

Contract Amount

Type of Project Est. Date of Completion

Name and Telephone Number to Contact For Information

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 Question 7a. or 7b., please specify location(s) and reason(s):

8. Organization that will be available for this project:

a. Minimum No. of employees: _______________ Maximum No. of employees: ________________

b. Are employees regularly on your payroll? ____ yes ____ no

c. If applicable, specify supplies, tools, equipment (list model, horsepower, and pice size capabilities), and facilities to be used for this contract:

d. If applicable, estimate rate of progress (such as 2.0 acres per day):

Minimum progress rate: __________________________ Maximum progress rate: ______________________

9. List the employees that would be assigned to perform janitorial services at the work site on this contract and their experience with Janitorial Services:

Individual's Name Present Position Years Experience Type of Work

10. Remarks: Additional pages may be added to provide additional information in this section.

Please include a list of bio‐based product if they will be used in performance of this contract. Applicable bio‐based products may include bathroom cleaners, carpet cleaners, glass cleaners, gerneral purpose household cleaners, mutiopurpose cleaners, drain cleaners, microbial cleaners or disinfectants.

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

Combined Synopsis/Solicitation 12569R18Q0026 J.W. Toumey Nursery Weeding