Attachment_1_Experience_Questionnaire.pdf

EXPERIENCE

QUESTIONNAIRE

1. CONTRACTOR NAME, ADDRESS, & TELEPHONE NUMBER

2. BUSINESS TYPE:

[ ] COMPANY

[ ] INDIVIDUAL

[ ] CORPORATION

[ ] CO-PARTNERSHIP

[ ] NON-PROFIT

3. HOW MANY YEARS DOES YOUR BUSINESS HAVE IN THE LINE OF WORK

CONTEMPLATED BY THIS SOLICITATION?

4. HOW MANY YEARS EXPERIENCE IN CONTRACTING HAS YOUR BUSINESS HAD AS AN;

(a) PRIME CONTRACTOR AND/OR (b) SUB-CONTRACTOR _?

IS THIS TIME CONCURRENT? [ ] YES [ ] NO

5a. LIST BELOW SIMILAR PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE YEARS:

CONTRACT

AMOUNT

TYPE OF PROJECT DATE

COMPLETED

NAME, ADDRESS & TELEPHONE NUMBER OF

OWNER/PERSON TO CONTACT FOR INFO.

5b. LIST BELOW THE PROJECTS THAT ARE INCOMPLETE:

CONTRACT

NUMBER

DOLLAR

AMT. OF

AWARD

NAME, ADDRESS &

PHONE NO. OF AGENCY

INVOLVED

PERCENT

COMPLETED

DATE

COMPLETED

UNITS

AWARDED

6a. HAVE YOU EVER FAILED TO COMPLETE ANY WORK AWARDED TO YOU? [ ] YES [ ] NO

6b. HAS WORK EVER BEEN COMPLETED BY PERFORMANCE BOND? [ ] YES [ ] NO

6c. IF “YES” TO EITHER ITEM 6a OR 6b, SPECIFY LOCATION(S) AND REASONS(S) WHY:

7. ORGANIZATION AND WORK THAT WILL BE AVAILABLE FOR THIS PROJECT:

a.(1) MINIMUM NO. OF EMPLOYEES: _ AND

(2) MAXIMUM NO. OF EMPLOYEES: __

b. ARE EMPLOYEES REGULARLY ON YOUR PAYROLL: [ ] YES [ ] NO

c. SPECIFY BELOW EQUIPMENT AVAILABLE FOR THIS CONTRACT:

d. ESTIMATE RATE OF PROGRESS BELOW (SUCH AS 2.0 ACRES/MAN/DAY:

(1) MINIMUM PROGRESS RATE: AND (2) MAXIMUM PROGRESS RATE:

8. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR BUSINESS:

INDIVIDUALS NAME

PRESENT

POSITION

YEARS OF

EXP.

MAGNITUDE AND TYPE OF WORK

(attach sheets if extra space is needed)

10. THE BIDDER SHALL INDICATE WHETHER OR NOT HE/SHE HAS EXAMINED THE AREAS FOR WHICH

THIS BID IS SUBMITTED: [ ] YES [ ] NO

IF YES, THE DATE AREA WAS EXAMINED: _ _

CERTIFICATION: I CERTIFY THAT ALL OF THE

STATEMENTS MADE BY ME ARE

COMPLETE AND CORRECT TO THE BEST OF MY

KNOWLEDGE AND

11a. CERTIFYING OFFICIAL’S NAME & TITLE

THAT ANY PERSONS NAMED AS REFERENCES ARE

AUTHORIZED TO FURNISH THE FOREST SERVICE

WITH INFORMATION NEEDED TO VERIFY MY

CAPABILITY TO

11b. SIGNATURE (Sign in ink)

PERFORM THIS PROJECT. 11c. DATE

9. REMARKS – SPECIFY BOX NUMBERS (also use this area to address any problems with past performance not noted in item 6):