Attachment_7_-_Experience_Questionaire.docx

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Attached to
Bathroom Remodel Federal contract opportunity
Solicitation number
1282D718R0002
Issued by
Department of Agriculture Forest Service R2-Rocky Mountain Region

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Experience Form - Return this one along with your bid form

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Solicitation No AG-82D7-S-17-0021 White River National Forest Difficult Campground Water System Improvements Attachment 3

EXPERIENCE QUESTIONNAIRE

1. CONTRACTOR NAME, ADDRESS AMD PHONE#

2. SUBMITTED TO (Office Name & Address)

USDA Forest Service White River National Forest 900 Grand Ave Glenwood Springs, CO 81601

3. BUSINESS:

___ Company ___ Co-partnership ___ Corporation ___ Individual __ Non-profit Organization

4. How many years of experience do you or your firm have in the line of work contemplated by this solicitation?

5. HOW MANY YEARS EXPERIENCE IN CONTRACTING HAVE YOU OR YOUR FIRM HAD AS A:

PRIME CONTRACTOR AND/OR SUB-CONTRACTOR____________________

6. LIST BELOW THE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE YEARS:

CONTRACT AMOUNT
TYPE OF

PROJECT

DATE COMPLETED
NAME, ADDRESS, & PHONE OF OWNER PERSONS TO CONTACT FOR PROJECT INFORMATION

7. LIST BELOW ALL OF YOUR CONTRACTUAL COMMITMENTS RUNNING CONCURRENTLY WITH THE

WORK CONTEMPLATED BY THIS PROJECT:

CONTRACT NUMBER
AMOUNT

OF AWARD

NAME, ADDRESS & PHONE # OF

BUSINESS/GOVERNMENT AGENCY INVOLVED

AWARDED (UNITS)
PERCENT COMPLETED
DATE COMPLETED

Solicitation No AG-82D7-S-18-___

Aspen Bunkhouse Bathrooms Remodel Attachment ___

8. (A) DESCRIBE A SITUATION WHERE THE CONTRACT PERFORMANCE PERIOD WAS NOT MET AND HOW IT WAS RESOLVED.

(B) DESCRIBE A SITUATION WHERE A PRICE CHANGE TO A CONTRACT WAS REQUESTED AND HOW IT WAS RESOLVED.

(C) DESCRIBE A SITUATION WHERE A WARRANTY ISSUE WAS RAISED BY THE OWNER AND HOW IT WAS RESOLVED.

(D) DESCRIBE A SITUATION WHERE A PROBLEM WAS ENCOUNTERED AND ANY CORRECTIVE ACTIONS TAKEN TO PREVENT A RECURRENCE.

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

INDIVIDUAL'S NAME

PRESENT POSITION
YEARS OF EXP.

MAGNITUDE AND TYPE OF WORK

Solicitation No AG-82D7-S-17-0021

Difficult Campground Water System Improvements Attachment 3

10. REMARKS: SPECIFY BOX NUMBERS (Attach sheets if extra space is needed to fully answer any of the above questions):

11. REFERENCES: (List Two - Name, Company and phone number)

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.

12a. CERTIFING OFFICIAL'S NAME AND TITLE

12 b. SIGNATURE (Sign in Black Ink)
13. DATE

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