02._Experience_Questionnaire.docx

AG-02RC-S-17-0133 / Slashing and Piling / NPC / North Fork R.D. Page 1 of 2 ATTACHMENT No. 02

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. 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:

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

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:

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. Estimated average rate of progress per day:________________________________________________________________

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

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR

ABILITY TO SUCCESSFULLY COMPLETE THIS PROJECT. MAY USE SEPARATE AND OR ADDITIONAL FORMS WHICH ADDRESS THE QUESTIONS IN THE EXPERIENCE QUESTIONNAIRE.

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