ATCH_2-_140L0119R0004_Experience_Questionnaire.docx
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- Attached to
- ACQUIRE OFF RANGE CORRAL
- Solicitation number
- 140L0119R0004
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ATTACHMENT II - EXPERIENCE QUESTIONNAIRE
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SOLICITATION NO 140L0119R0004
ATTACHMENT 2
CONTRACTOR EXPERIENCE QUESTIONNAIRE
OFF RANGE CORRAL
140L0119R0004
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 8, Remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
1. Contractors Representative Name, Address, & Telephone No.
2. Type of Business:
[ ] Company [ ] Co-Partner [ ] Corporation [ ] Individual [ ] Non-profit Organization
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. Attach a list or list the projects the Contract Representative has completed in the last 3 years:
| Contract Amount |
| Type of Project |
| Date Completed |
| Name, Address, & Telephone no. to Contact for Information. |
| 6a. Have contract representative ever fail to complete any work awarded to you? |
| [ ] Yes |
| [ ] No |
| 6b. Has the contract representative work ever been completed by performance bond? |
| [ ] Yes |
| [ ] No |
6c. If ‘Yes’ was checked to either item 6a or 6b, specify location(s) and reason(s) why:
7. List the experience of the principal individuals that will be working on this project
| Individuals Name |
| Present Position |
| Years of Experience |
| Type of Work |
8. 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.
| Printed Name |
| Signature |
| Title |
| Date |
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