Experience_Capability Statement.doc

MIDEWIN INFRASTRUCTURE DEMOLITION

Removal and Disposal of Foundations and Structures

Midewin National Tallgrass Prairie

CIM-0915-11F-188-0915-01

(This page must be included with quotation submission.)

Company Name

Date

Contractor’s Name

Company Address

Phone number

Cell phone number

Fax number email

Duns Number

Tax ID Number Instructions: Mark “X” in the appropriate boxes. Please list NA for inapplicable items.

1. Type of Business

(Please check appropriate line.)

Company

Corporation

Non-profit Organization

Co-partner

Individual

2. How many years of experience do you have in this line of work? ______________________

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

4. List the projects your business has completed in the last 3 years.

Contract

Amount

Completed Name and Telephone Number to

Contact for Information/Reference

5. List all of your firm’s current contract commitments.

Contract

Number Contract

Amount

Completion Name and Telephone Number to

Contact For Information/Reference

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 Question 6a. or 6b., please specify location(s) and reason(s):

7. 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, estimate rate of progress (i.e., acres per day):

Minimum progress rate: _______________ Maximum progress rate: ____________

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

9. Please list three references for like-kind work.

Name

Phone

1. ___________________________________

2. ___________________________________

3. ___________________________________

10. Please list equipment (make, model, year) that will be used:

1. _________________________________________________________________________

2. _________________________________________________________________________

3. _________________________________________________________________________

11. Remarks: (Please describe the contractor’s past experience with bush-hogging and using chainsaws, as well as the number of years of experience with each activity. Attach additional pages if necessary).

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

PAGE