Questionnaire_of_Bidder's_Responsibility_(1pg).doc

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Attached to
421 tons SB2 Class 7 - White River NWR, AR Federal contract opportunity
Solicitation number
140F0418Q0119
Issued by
Department of the Interior Fish and Wildlife Service Region 9 Headquarters

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Questionnaire of BidderAs/OfferorAs Responsibility

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QUESTIONNAIRE OF BIDDER’s/OFFEROR’s RESPONSIBILITY Bidder’s DUNs Number:_________________

Bidder's Name, Address

Telephone #: ________________________

Facsimile #: ________________________ *Number of Employees *Average Annual Gross Revenues __ 50 or fewer __ $1 million or less

__ 51-100 __ $1,000,001-$2 million

__ 101-250 __ $2,000,001-$3.5 million

__ 251-500 __ $3,500,001-$5 million

__ 501-750 __ $5,000,001-$10 million

__ 751-1,000 __ $10,000,001-$17 million

__ Over 1,000 __ Over $17 million (*The information contained above is not mandatory and used only to aid in determining business Size Standard)

How long in present business? ________________________________ Type of Organization:

[ ] Individual

[ ] Individual doing business as a Firm [ ] Partnership

[ ] Joint Venture [ ] Corporation, Incorporated under the laws of the State of _______________________ [ ] Non-Profit Organization Names of Officers, Owners, or Partners:

Owners or Partners: ___________________________________ President: _________________________________ Vice President: ____________________________ Treasurer: _________________________________ Secretary: ________________________________ Individuals and their telephone numbers authorized to sign bids, offers, and contracts in your name:

1. _____________________________________________________

2. _____________________________________________________ Name, address, and telephone number of persons for organization of similar projects completed during the past three years. (Preferably Government Type - (Federal, State, County):

1. _______________________________________________________________________________

2. _______________________________________________________________________________

3. _______________________________________________________________________________ Name and telephone number of person for organization of similar projects in progress:

1. _______________________________________________________________________________

2. _______________________________________________________________________________

3. _______________________________________________________________________________

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