A07c_Experience_Questionnaire.doc

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San Juan National Forest, San Juan Public Lands Center Janitorial Services
Solicitation number
1282CS20Q0010
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Solicitation: 1282CS20Q0010 San Juan Public Lands Center 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.

2. Type of Business ___Company ___Co-Partner ___Non-profit ___Corporation ___Individual

3. How many years experience do you have in this line of work_______Yrs

4. How many years experience as a prime contractpr________subcontractor______

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

CONTRACT

NUMBER

AWARD

AMOUNT

NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO.
PERCENT

COMPLETED

DATE CONTRACT

COMPLETED

6. List all of your firms current contract commitments

CONTRACT

NUMBER

AWARD

AMOUNT

NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO.
PERCENT

COMPLETED

7. Have you ever failed to complete any work awarded to you? ____yes ____ no

If "yes" 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:

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

INDIVIDUALS NAME
PRESENT POSITION
YRS EXP
TYPE OF WORK

10. 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:

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