Experience_Questionaire.pdf

USDA Forest Service

RELEVANT 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)

USDA Forest Service Mt Hood National Forest 16400 Champion Way Sandy, Oregon 97055

3. Business [ ] Company [ ] Corporation [ ] Non-profit Organization [ ] Co-partnership [ ] Individual

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 relevant projects your business has completed within the last three years:

Contract Amount

Type of Project Date Completed Name, Address, and Telephone No. of

Owner/Person to Contact for Project Information

7. List below all of your firm’s commitments on other BPAs or IDIQs

BPA/IDIQ Number

Contracting Officer

Name the Government Agency Awarded Date

Length of Award

RELEVANT EXPERIENCE QUESTIONNAIRE, CONTINUED

9. Employees and equipment that will be available for possible Calls/Orders:

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

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

c. If applicable, specify equipment available for items on the schedule of items:

d. Estimate rate of progress below (such as 2.0 acres/man/day):

(1) Minimum progress rate: _________________ and (2) Maximum progress rate: ___________________

10. List below the experience of the Personnel to work on future BPA Calls.

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 PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO SUCCESSFULLY

COMPLETE BPA CALLS

CERTIFICATION

I certify that all of the statements made by me 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 work on BPA Calls/Orders.

12a. CERTIFYING OFFICIAL’S NAME AND TITLE

b. SIGNATURE (Sign in blue ink) 13. DATE