A22 21Q0005 Attachment A - Contractor Experience Questionnaire.pdf

ADDITIONAL INFORMATION:

Attachment A:

CONTRACTOR EXPERIENCE QUESTIONNAIRE

SOLICITATION NUMBER: W912ES21Q0005

PROJECT TITLE: USACE St. Paul District ASL Services

PLEASE COMPLETE ALL REQUESTED INFORMATION:

Company Name: _____________________________________

Street Address: _____________________________________

City: ___________________ State: __________ Zip: ______________

Cage Code: ____________________ Tax ID: _______________

WILL YOU BE PERFORMING THIS WORK?

YES (IF YES, PLEASE SUPPLY COMPANY EXPERIENCE)

NO (IF NO, PLEASE SUPPLY EXPERIENCE OF SUBCONTRACTOR)

Company Name:

Experience with Sign Language Interpretation Services: Years _____ Months ________

Number of Interpreters Available: _________

Interpreters Available for this contract:

Employee Name: _______________________________ Certification Type: ______________________________ Experience with Sign Language Interpretation: Years _________ Months _________

ADDITIONAL INFORMATION:

Employee Name: _______________________________ Certification Type: ______________________________ Experience with Sign Language Interpretation: Years _________ Months _________

Employee Name: _______________________________ Certification Type: ______________________________ Experience with Sign Language Interpretation: Years _________ Months _________

Employee Name: _______________________________ Certification Type: ______________________________ Experience with Sign Language Interpretation: Years _________ Months _________

Customer References: Provide a list of at least 3 customer references.

Customer Reference Name 1: ___________________________

When last service was performed: _______________________

Value of last service: _________________________________

Reference Phone Number: _____________________________

Customer Reference Name 2: ___________________________

When last service was performed: _______________________

Value of last service: _________________________________

Reference Phone Number: _____________________________

Customer Reference Name 3: ___________________________

When last service was performed: _______________________

Value of last service: _________________________________

Reference Phone Number: _____________________________

Please return this data sheet along with your quote.