Attch06_ExpQuest.rtf

AG-02RC-S-15-0044

Attachment 01

6/15/2015 AG-02RC-S-15-0091

Attachment 01 USDA Forest Service

EXPERIENCE QUESTIONNAIRE

INSTRUCTIONS: See Box 11, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.

1. CONTRACTOR NAME, ADDRESS, AND TELEPHONE NUMBER

2. SUBMITTED TO (Office Name and Address)

3. TYPE BUSINESS

[ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual [ ] Non-profit Organization

4. How many years do you or your firm have in the line of work contemplated by this solicitation?

5. How many years’ experience have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?

6. List below the projects your business has completed within the last three years (private and federal):

CONTRACT AMOUNT

TYPE OF PROJECT

DATE COMPLETED

NAME, ADDRESS & TELEPHONE # OF OWNER/PERSON TO CONTACT FOR PROJECT INFORMATION

7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

CONTRACT NUMBER

DOLLAR AMT. OF AWARD

NAME, ADDRESS, AND TELEPHONE NO. OF BUSINESS/GOVERNMENT AGENCY INVOLVED

AWARDED (UNITS)

PERCENT COMPLETE

DATE CONTRACT COMPLETED

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. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:

(OVER)

9. Organization and work that will be available for this project:

a. (1) Minimum number of employees: _____ and a (2) Maximum number of employees: _____?

b. Are employees regularly on your payroll: [ ] Yes [ ] No

c. Specify the type, size, and use of equipment available for this contract:__________________________________________

INDIVIDUAL’S NAME

PRESENT POSITION

YEARS OF EXPERIENCE

MAGNITUDE AND TYPE OF WORK

11. REMARKS-SPECIFY BOX NUMBERS (Attach sheets if extra space is needed to fully answer any above question.):

NOTE: Please use the below space to outline your Technical Capability, Past Performance, and Relevant Experiance. Additional sheets can be provided if necessary.

Clause 452.237-74 KEY PERSONNEL – include the below positions

CERTIFICATION

I certify that all of the statements made by me are complete and correct t 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

b. SIGNATURE (Sign in ink)

13. DATE

10. List below the experience of the principal individuals of your business: (Who will directly be involved in this contract?)