2019 NRS Attachment C EXPERIENCE QUESTIONNAIRE.docx

EXPERIENCE QUESTIONNAIRE

Contractor name, address, phone, email & DUNS number:

ATTACHMENT C

1. Submitted to: (Office Name & Address) USDA Forest Service, NRS, Colleen Reittinger 1 Gifford Pinchot Dr.

Madison, WI 53726

3. Business:

__Company ___Co-partnership __Corporation ___Individual __Non-profit Organization

4. How many years does your firm have in the line of work described in 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 $

COMPLETED

Include ALL of the following: COMPANY OR AGENCY NAME, ADDRESS, PERSON TO CONTACT FOR PROJECT INFORMATION, PHONE, & EMAIL:

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

WORK CONTEMPLATED BY THIS PROJECT: Will your designated crew leader (s) be involved in these commitments?

CONTRACT

NUMBER

AMOUNT

OF AWARD $

Months to complete

PERCENT

COMPLETED

PLANNED

Compleate Date Name of Crew Leader(s) associated with this contract and this FIA contract

8a. HAVE YOU EVER FAILED TO COMPLETE ANY WORK AWARDED TO YOU? ______YES _____NO

8b. HAS WORK EVER BEEN COMPLETED BY PERFORMANCE BOND? ______YES _____NO

8c. HAVE ANY OF YOUR CONTRACTS BEEN TERMINATED DUE TO PERFORMANCE ? ______YES _____NO

8d. IF “YES” TO 8a. – c. SPECIFY LOCATION(S) AND REASON(S)WHY:

ATTACHMENT C - EXPERIENCE QUESTIONNAIRE

9. ORGANIZATION AND WORKERS THAT WILL BE AVAILABLE FOR THIS PROJECT:

a. MINIMUM # OF CREW LEADERS:___________ AND MAXIMUM # OF CREW LEADERS:__________

b. ARE THESE EMPLOYEES REGULARLY ON YOUR PAYROLL? ______YES _______ NO

c. SPECIFY EQUIPMENT AVAILABLE FOR THIS CONTRACT:______________________________________

d. ESTIMATE RATE OF PROGRESS BELOW (SUCH AS 1.0 PLOTS/ CREW LEADER/DAY):

MINIMUM PROGRESS RATE:_________________ AND MAXIMUM PROGRESS RATE:___________

10a. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR BUSINESS THAT WILL BE ASSIGNED TO COMPLETE THE FIELD WORK ASSOCIATED WITH THIS CONTRACT

Individual: Name, Position or Title in Company

Classification: Enter CL for Crew Leader, enter PL for Project Leader, or enter CL/PL if both:

Education: List the Highest Level Completed and Location: (High School, Associates, Bachelors or Graduate degree)

Degree Major or Area of Studies

Experience: List specific description of crew leader’s experience with forest, urban, vegetative, or street tree inventories. Include work experiences completing stand exams, canopy and ground cover inventories or CFI plot work. Separate out each type of work and include number of months experience for each type of work. Start with most recent.

Individual: Name, Position or Title in Company

Classification: Enter CL for crew leader, enter PL for project leader, or enter CL/PL if both:

Experience: List specific description of crew leader’s experience with forest, urban, vegetative, or street tree inventories. Include work experiences completing stand exams, canopy and ground cover inventories or CFI plot work. Separate out each type of work and include number of months experience for each type of work. Start with most recent.

Individual: Name, Position or Title in Company

Classification: Enter CL for crew leader, enter PL for project leader, or enter CL/PL if both:

Education: List the Highest Level Completed and Location: (High School, Associates, Bachelors or Graduate degree)

Degree Major or Area of Studies

Experience: List specific description of crew leader’s experience with forest, urban, vegetative, or street tree inventories. Include work experiences completing stand exams, canopy and ground cover inventories or CFI plot work. Separate out each type of work and include number of months experience for each type of work. Start with most recent.

11a. Remarks: Specify box numbers: (Add text here if extra space is needed to fully answer any of the above questions):

Failure to provide complete information will cause affected portions of the bid evaluation to be considerd as unresponsive.

This form is the ONLY format in which this data will be accepted, other formats will be considered as unresponsive.

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. CERTIFYING OFFICIAL’S NAME AND TITLE

12b. SIGNATURE

13. DATE