Atch6_ExperiencePastPerfQuestionnaire.pdf

EXPERIENCE AND CAPABILITY QUESTIONNAIRE

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 is needed or in another format provide identical information.

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

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 the projects your business has completed in the last 3 years.

Contract Amount Type of Project Date Completed Name & Telephone Number to Contact

For Information

6. List all of your firm’s current contract commitments.

Contract Number

Contract Amount

Type of Project Est. Date of Completion

Name & 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):

8. Organization that will be available for this project:

Permit Dive Monitoring & Reporting Service AG-0120-S-16-0018

a. Minimum No. of employees: __________ Maximum No. of employees; ______________

b. Are employees regularly on your payroll? _______ Yes, ________ No

c. If applicable, specify equipment available for this contract:

d. If applicable, estimate rate of progress (such as 2.0 acres per day):

Minimum progress rate: _____________________________________________ Maximum progress rate: _____________________________________________

9. List experience of the principal individuals of your business Individual’s Name Present Position Years Experience Type of Work

10. Remarks:

CERTIFICATION: I certify that all of the statements made above 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.

Signature Title Date

Permit Dive Monitoring & Reporting Service AG-0120-S-16-0018