ATTACHMENT 3 4 AG-4146-S-12-0012 MS Word.docx

Manual Forest / Silvicultural Services IDIQ- NFsAL AG-4146-S-12-0012 ATTACHMENT 3 –Experience Questionnaire Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.

1. Contractors Name, Address & Telephone No.

2. Type of Business __Company __Co-Partner __Non-profit __Corporation __Individual

3. Howmany years experience do you have in this line of work____Yrs

4. How many years experience as a prime contractor_____ subcontractor___

5. LIST OF PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST 3 YEARS

NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included. (i.e. Type of manual forest/silvicultural work performed (i.e. pre-commercial thinning, herbicide application, tree planting) quantities/acres involved, other type of similar work accomplished, type of equipment used (i.e. chain saws, back packs, hand tools) Use of only a project title does not usually provide enough detail for the Government to make an evaluation.

Project & Location ______________________________________________________________________________________________ Contract Number:_______________________________ Award Amount: ________________________________________________ Period of Performance and/or completion date: ________________________________________________________________________ Client/Company’s Name/Address: __________________________________________________________________________________ Contact Name, email and Telephone number: ________________________________________________________________________ Description of Services (refer to note in No. 5 type of manual forest/silvicultural work performed, quantities involved, etc.) ______________________________________________________________________________________________________________

Project & Location ______________________________________________________________________________________________ Contract Number:_______________________________ Award Amount: ________________________________________________ Period of Performance and/or completion date: ________________________________________________________________________ Client/Company’s Name/Address: __________________________________________________________________________________ Contact Name, email and Telephone number: ________________________________________________________________________ Description of Services (refer to note in No. 5 type of manual forest/silvicultural work performed, quantities involved, etc.) ______________________________________________________________________________________________________________

Project & Location ______________________________________________________________________________________________ Contract Number:_______________________________ Award Amount: ________________________________________________ Period of Performance and/or completion date: ________________________________________________________________________ Client/Company’s Name/Address: __________________________________________________________________________________ Contact Name, email and Telephone number: ________________________________________________________________________ Description of Services (refer to note in No. 5 type of manual forest/silvicultural work performed, quantities involved, etc.) ______________________________________________________________________________________________________________

Project & Location ______________________________________________________________________________________________ Contract Number:_______________________________ Award Amount: ________________________________________________ Period of Performance and/or completion date: ________________________________________________________________________ Client/Company’s Name/Address: __________________________________________________________________________________ Contact Name, email and Telephone number: ________________________________________________________________________ Description of Services (refer to note in No. 5 type of manual forest/silvicultural work performed, quantities involved, etc.) ______________________________________________________________________________________________________________

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

6. If "yes" to either item 6a or 6b specify location(s) and reason(s) why

7. US Dept of Labor MSPA Registration No. _______________________Expiration Date:__________________________ Copy Attached. If not explain____________________________________________________________________________

8. State Pesticide (or reciprocal l) Contractor’s License(s)_____________________________ Expiration Date:_____________________ Applicators License(s) . _____________________________Expiration Date:_____________________ Applicators License(s) . _____________________________Expiration Date:_____________________ Attach copy(s) If not currently in possession of the license(s), explain: _________________________________________

9. List the experience of the primary individuals to perform on proposed project

10. Information required to complete a responsibility determination of the apparent successful offeror. (Additional information may be requested once a contractor is selected for award.. Moreover, the contractor might need to provide additional authorization from a creditor to grant access.)

a. Credit References

b. Banking Information.

11. REMARKS (Additional sheets may be attached to the experience questionnaire)

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 this project:

Name:

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 this project:

Name:

ATTACHMENT 4 – Past Performance Questionnaire (PPQ)

SECTION I: CONTRACTOR INFORMATION

A. Your Company Name and Address:_____________________________________________________

B. Phone /Fax #: _____________________________________________________________________

C. Point of Contact/email address: ________________________________________________________

D Authorization is hereby granted to provide the information requested in SECTION II and III of this questionnaire.

Signature of Authorized Contractor Representative Date

Printed Name and Title of Authorized Contractor Representative

SECTION II: RESPONDENT INFORMATION: Request a reference from respondent by completing Section II and III and return as directed by contractor requesting the reference.

A. Client/Reference Name and Address: ___________________________________________________

B. Phone/Fax #: ______________________________________________________________________

C. Point of Contact/email address: ________________________________________________________

D. Reference Contract Number: __________________________________________________________ Project Title _______________________________________________________________________ Contract Value/Type: ________________________________________________________________ Period of Performance: _______________________________________________________________ How long have you worked with the contractor: ___________________________________________ More detailed description of the work performed____________________________________________

E. Date completed: ___________________________________________________________________

SECTION III: PERFORMANCE EVALUATION

A. CONTRACT PERFORMANCE

B. QUALITY OF SERVICE/CONTROL

TIMELINESS OF PERFORMANCE

REMARKS: For ratings above or below satisfactory, please provide remarks to describe the reasons for the rating. If additional remarks are necessary, please attach an additional sheet. ____________________________________________________________