Experience_Questionaire.docx

J.3

EXPERIENCE QUESTIONNAIRE

1. CONTRACTOR NAME, ADDRESS, & TELEPHONE NUMBER

1. BUSINESS TYPE

[ ] COMPANY

[ ] INDIVIDUAL

[ ] CORPORATION

[ ] CO-PARTNERSHIP

[ ] NON-PROFIT ORGANIZATION

3. HOW MANY YEARS DOES YOUR BUSINESS HAVE IN THE LINE OF WORK CONTEMPLATED BY THIS SOLICITATION?

4. HOW MANY YEARS EXPERIENCE IN CONTRACTING HAS YOUR BUSINESS HAD AS AN (a) PRIME CONTRACTOR __________ AND/OR (b) SUB-CONTRACTOR __________? IS THIS TIME CONCURRENT? ___________

5a. LIST BELOW SIMILAR PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE YEARS:

CONTRACT

AMOUNT

COMPLETED

NAME, ADDRESS & TELEPHONE NUMBER OF

OWNER/PERSON TO CONTACT FOR INFO.

5b. LIST BELOW THE PROJECTS THAT ARE INCOMPLETE:

CONTRACT

NUMBER

DOLLAR AMT.

OF AWARD

NAME, ADDRESS & PHONE NO.

OF AGENCY INVOLVED

COMPLETED

UNITS

AWARDED

6a. HAVE YOU EVER FAILED TO COMPLETE ANY WORK AWARDED TO YOU? [ ] YES [ ] NO

6b. HAS WORK EVER BEEN COMPLETED BY PERFORMANCE BOND? [ ] YES [ ] NO

6c. IF “YES” TO EITHER ITEM 6a OR 6b, SPECIFY LOCATION(S) AND REASONS(S) WHY:

7. ORGANIZATION AND WORK THAT WILL BE AVAILABLE FOR THIS PROJECT:

a.(1) MINIMUM NO. OF EMPLOYEES: __________ AND a.(2) MAXIMUM NO. OF EMPLOYEES: __________

b. ARE EMPLOYEES REGULARLY ON YOUR PAYROLL: [ ] YES [ ] NO

c. SPECIFY EQUIPMENT AVAILABLE FOR THIS CONTRACT:

d. ESTIMATE RATE OF PROGRESS BELOW (SUCH AS 2.0 ACRES/MAN/DAY:

(1) MINIMUM PROGRESS RATE: __________ AND (2) MAXIMUM PROGRESS RATE: __________

8. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR BUSINESS:

INDIVIDUALS NAME

PRESENT

POSITION

YEARS

OF EXP.

MAGNITUDE AND TYPE OF WORK

9. REMARKS – SPECIFY BOX NUMBERS (also use this area to address any problems with past performance not noted in item 6):

(attach sheets if extra space is needed)

10. THE BIDDER SHALL INDICATE WHETHER OR NOT HE/SHE HAS EXAMINED THE AREAS FOR WHICH

THIS BID IS SUBMITTED: [ ] YES [ ] NO

IF YES, THE DATE AREA WAS EXAMINED: _________________________

PERFORM THIS PROJECT.

11c. DATE