Attachment_4_-_Experience_Questionaire.docx

EXPERIENCE QUESTIONNAIRE

1. CONTRACTOR NAME, ADDRESS AMD DUNS and PHONE#

2. SUBMITTED TO (Office Name & Address)

USDA Forest Service White River National Forest 900 Grand Ave Glenwood Springs, CO81601

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:

PROJECT

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

WORK CONTEMPLATED BY THIS PROJECT:

OF AWARD

NAME, ADDRESS & PHONE # OF

BUSINESS/GOVERNMENT AGENCY INVOLVED

Solicitation No 1282D719R0002 Medicine Bow Routt National Forest Saratoga Bunkhouse Construction Attachment 4

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

MAGNITUDE AND TYPE OF WORK

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