J.11_-_EXP_AND_PP_QUEST.pdf

J-11

EXPERIENCE AND PAST PERFORMANCE QUESTIONNAIRE

Instructions: See Box 10, REMARKS, if extra space is needed to answer any items below. Mark "X" in the appropriate boxes. Please list NA for inapplicable items.

1. Contractor's Name, Address & Telephone Number 2. Type of Business ____ Company ____ Corporation ____ Non-profit Organization ____ Co-partner ____ Individual

3. How many years of experience do you have in this line of work? ___________________

4. How many years of experience as a prime contractor? _________ subcontractor? ________

5. List similar projects your business has completed in the last 5 years.

Contract Amount

Type of Project Date Comple ted

Name and Telephone Number to Contact For Information

6. List all of your firm's current contract commitments.

Contr act Numb er

Contr act Amou nt

Type of Project

Est. Date of Completi on

Name and Telephone Number to Contact For Information

EXPERIENCE AND PAST PERFORMANCE QUESTIONNAIRE (cont )

7a. Have you ever failed to complete any work awarded to you? ____ yes ____ no

7b. Has work ever been completed by performance bond? ____ yes ____ no

7c. If "yes" to either Question 7a. or 7b., please specify location(s) and reason(s):

8. Organization that will be available for this project:

a. Minimum No. of employees: _______________ Maximum No. of employees: ________________

b. Are employees regularly on your payroll? ____ yes ____ no

c. If applicable, specify equipment or any other specifics available for this contract:

9. List the experience of the principal individuals of your business.

Individual's Name Current Position

# Years Experience

Comparable Type of Work

EXPERIENCE AND PAST PERFORMANCE QUESTIONNAIRE (cont )

12. Quality Control Plan – Submit as part of your prposal specific information that outlines how offeror (and any subcontractors) will provide quality assurance in the areas of Common Stand Exam and/or Stocking Surveys, provide as an attachment to your technical proposal write-up or include in your technical proposal write-up.

11. Remarks:

CERTIFICATION: I certify that all of the statements made above 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 this project.

Signature Title Date