ATCH_4_Exp_Questionnaire.doc

AG-03K0-S-09-0025

EXPERIENCE QUESTIONNAIRE

Name of Contractor: ________________________ Attention: Completion of this Questionnaire is required in order for your proposal to be considered “Responsive”. Please provide information that is relevant to this project (road construction/reconstruction).

Please list in the table below your work experience over the last three years.

Amount Date Completed Customer/Reference Information

Name Address Phone

Please list in the table below the equipment that will be utilized on this project.

Condition Owned or Rented

Please answer the following questions.

· How many years experience do you have with this type of work? ___________________________________

· Do you have any other contractual commitments that may run concurrently with this solicitation? _________

· If the answer to the above is yes, please list these projects here.______________________________________

Please complete the following table for the employees that will be working on this project.

Employee

Name Employee

Classification Employment Status Permanent Seasonal

Qualified?

· Have you ever been defaulted on any Federal Government contract? ______________________

· If the answer to the above is yes, explain the circumstances and list the name of the Contracting Officer.

In addition to the above information please address all of the required information in Section M of this project (page 58 of 58) as a separate submittal.

ATTACHMENT 4