J.8_Experience_Questionnaire.doc
DOC document 83 KB Posted
- Attached to
- Medicine Bow/Routt National Forests and Thunder Basin National Grassland - Road Maintenance IDIQ
- Solicitation number
- 1282D719R0007
About this file
J.8 Experience Questionnaire
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Text version
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 |
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 |
10. REMARKS: SPECIFY BOX NUMBERS (Attach sheets if extra space is needed to fully answer any of the above questions):
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.
11a. CERTIFING OFFICIAL'S NAME AND TITLE
| 11 b. SIGNATURE (Sign in Black Ink) |
| 12. DATE |
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