EXPERIENCE AND CAPABILITY QUESTIONNAIRE.pdf

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Two 40 HP Yamaha Jet Ouboards NLT 15 Sept 2011.
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AG-0116-S-11-0066
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OMB Questionnaire.

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EXPERIENCE AND CAPABILITY QUESTIONNAIRE -- OMB Clearance

Number 9000-0142

Instructions: See Box 10, REMARKS, if extra space is needed to answer any items below. Mark "X" in the appropriate boxes. Please list NA for inapplicable items. Offerer should copy if extra space needed or in another format provide identical information.

1. Contractor's Name, Address & Telephone Number 2. Type of Business

____ Company

____ Corporation

____ Non-profit Organization

____ Co-partner

____ Individual

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

4. How many years of experience as a prime contractor? _________ subcontractor? ________

5. List no more than 5 similar projects your business has completed in the last 3 years.

Contract

Amount

Type of Project Date

Completed

Name and Telephone Number to

Contact For Information

6. List no more than 5 of your firm's current contract commitments.

Contract

Number

Contract

Amount

Type of Project Est. Date of

Completion

Name and Telephone Number to

Contact For Information

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" to either Question 7a. or 7b., please specify location(s) and reason(s):

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