A-11_Attachment_10_ExperienceQuestionnaire.docx

Experience Questionnaire Instructions: See Box 10, Remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

1. Contractors Name, Address, & Telephone No.

Email: @ .

2. Type of Business: (Include letter of authorization on who can bind or sign for company) see FAR 4.102

3. How many years experience do you have in this line of work? Years

4. How many years experience as a prime contractor? As a subcontractor?

5. Relevant Projects: Provide information requested in Factor 2.1 on relevant projects your business has completed in the last 3 years:

6. List below all of your firm’s contractual commitments running concurrently this solicitation

7a. Have you ever failed to complete any work awarded to you? |_| Yes |_| No 7b. Has work ever been completed by performance bond? |_| Yes |_| No 7c. If ‘Yes’ was checked to either item 7a or 7b, specify location(s) and reason(s) why:

7d. Did you look at the project site(s) on-the-ground? |_| Yes |_|No

8. Organization that will be available for this project:

a. |_| All work performed by prime, OR |_| Subcontracting % to be performed by sub. (Include information on Subcontractors)

b. Minimum number of employees: and Maximum number of employees:

c. Are employees regularly on your payroll? |_| Yes |_| No

d. Specify equipment available for this contract:

e. Estimate rate of progress (Such as acres/day, miles/day, or other rate):

Minimum progress rate: Maximum progress rate:

9. List the experience of the principal individuals of your business that will be assigned to this project:

10. Factor 3.1 Biobased Product Use:

a. Products to be used on this contract: (Provide justification if using non-designated products.)

a. Provide experience of using sustainable products on past contracts:

b. Cost of Biobased Products to be used on this contract:

11. Remarks:

12. 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 capabilities to perform this project.

Experience Questionnaire – Page 2 Instructions: See Box 10, Remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

7a. Have you ever failed to complete any work awarded to you? |_| Yes |_| No 7b. Has work ever been completed by performance bond? |_| Yes |_| No 7c. Did you look at the project site(s) on-the-ground? |_| Yes |_|No 7d. If ‘Yes’ was checked to either item 7a or 7b, specify location(s) and reason(s) why:

8. Organization that will be available for this project:

f. |_| All work performed by prime, OR |_| Subcontracting % to be performed by sub. (Include information on Subcontractors)

g. Minimum number of employees: and Maximum number of employees:

h. Are employees regularly on your payroll? |_| Yes |_| No

i. Specify equipment available for this contract:

j. Estimate rate of progress (Such as acres/day, miles/day, or other rate):

Minimum progress rate: Maximum progress rate:

9. List the experience of the principal individuals of your business that will be assigned to this project:

12. 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 capabilities to perform this project.