Attachment_2_-_3_in_MS_word_format.docx

Landlines Maintenance IDIQ, NFsMS AG-47U-S-16-0002

ATTACHMENT 2

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 8, 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. How many years of experience do you have in this line of work____ Years

4. How many years of experience as a prime contractor_____ subcontractor___

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

NOTE: Detailed description of boundary maintenance completed (i.e. work location, crew size, miles completed, type of vegetation, type of encroachment reports/maps), 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 and Telephone number: ___________________________________________________________________ Description of Services (refer to note in No. 5 above ) Detailed description of boundary maintenance work completed.

Project & Location ___________________________________________________________________________________ Contract Number:_______________________________ Award Amount: _____________________________________ Period of Performance and/or completion date: _____________________________________________________________ Client/Company’s Name/Address: _______________________________________________________________________ Contact Name and Telephone number: ___________________________________________________________________ Description of Services (refer to note in No. 5 above ) Detailed description of boundary maintenance work completed.

Project & Location ___________________________________________________________________________________ Contract Number:_______________________________ Award Amount: _____________________________________ Period of Performance and/or completion date: _____________________________________________________________ Client/Company’s Name/Address: _______________________________________________________________________ Contact Name and Telephone number: ___________________________________________________________________ Description of Services (refer to note in No. 5 above ) Detailed description of boundary maintenance work completed.

Project & Location ___________________________________________________________________________________ Contract Number:_______________________________ Award Amount: _____________________________________ Period of Performance and/or completion date: _____________________________________________________________ Client/Company’s Name/Address: _______________________________________________________________________ Contact Name and Telephone number: ___________________________________________________________________ Description of Services (refer to note in No. 5 above ) Detailed description of boundary maintenance work completed.

Project & Location ___________________________________________________________________________________ Contract Number:_______________________________ Award Amount: _____________________________________ Period of Performance and/or completion date: _____________________________________________________________ Client/Company’s Name/Address: _______________________________________________________________________ Contact Name and Telephone number: ___________________________________________________________________ Description of Services (refer to note in No. 5 above ) Detailed description of boundary maintenance work completed.

6a. Have you ever failed to complete any work awarded to you? __yes __ no

6b. Have you defaulted on any work? __yes __ no

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

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

8. 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:

ATTACHMENT 3

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

SECTION A: CONTRACTOR INFORMATION

A. Contractor’s Name and Address: ________________________________________________

B. Point of Contact: ______________________________________________________________

C. Phone #: ____________________________________________________________________

D. Contract Number: ______________________ Contract Type: ________________________

E. Project Title: _________________________________________________________________

F. Period of Performance: _________________________________________________________

G Description of Services (Description of work completed (i.e. type of equipment used, crew size, work location, acres completed, type of debris/vegetation)

Use of only a project title does not usually provide enough detail to determine what work was performed.

H. Authorization is hereby granted to provide the information requested in SECTION B of this questionnaire.

Signature of Authorized Contractor Representative Date

Printed Name and Title of Authorized Contractor Representative

RESPONDENT (CUSTOMER) INFORMATION:

A. Company Name : _______________________________________________________________ B. Name/Position of person completing questionnaire:_____________________________________ C. Telephone Number:_____________________________ Fax Number: _____________________ D. Address:_______________________________________________________________________ E. Relationship and Time Involved with Contractor:______________________________________ F. Date Questionnaire Completed:_______________________

E

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._____________________________________________________________