Attachment_04_Experience_Questionnaire.docx
DOCX document 18 KB Posted
- Attached to
- Moses Creek -East Fork AOP Culvert Replacement Federal contract opportunity
- Solicitation number
- AG-4568-S-17-0028
- Issued by
- Department of Agriculture Forest Service
About this file
Attachment 04- Experience Questionnaire
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| SF-30_Amendment_02.pdf | ||
| Moses_Creek_AOP_Culvert_Replacement_PreBid_Q&A.docx | DOCX document | |
| Moses_Creek_AOP_Pre-Bid_Sign-In_Sheet_07182017.pdf | ||
| Attachment_03_Revised_Schedule_of_Items_07312017.xlsx | XLSX spreadsheet | |
| Attachment_02_Moses_Creek_AOP_DwgRev2_07312017.pdf | ||
| Attachment_02_NFSR_Moses_Creek_SUP_SPECS_Revised_07312017.doc | DOC document | |
| Amendment_01_Attachment_02.pdf | ||
| Amendment_01_SF-30.pdf | ||
| Amendment_01_Attachment_03_Schedule_of_Items.xlsx | XLSX spreadsheet | |
| Sol__Body_AG-4568-S-17-0028.rtf | RTF text file | |
| Attachment_03_Schedule_of_Items.xlsx | XLSX spreadsheet | |
| Attachment_02_SOW.pdf | ||
| SF-1442.pdf | ||
| Attachment_01.docx | DOCX document | |
| DRAFT_NFSR_Moses_Creek_SUP_SPECS.doc | DOC document | |
| 03-30-17_Moses_Creek_East_Fork_Binder.pdf |
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Text version
AG-4568-S-17-0028
NFNC Nantahala RD Moses Creek AOP Culvert
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
1. Contractors Name, Address & Telephone No. Email
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 contractpr_____ subcontractor___
5. List the projects your business has completed in the last 3 years
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO. |
| PERCENT |
COMPLETED
DATE CONTRACT
COMPLETED
6. List all of your firms current contract commitments
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO. |
| PERCENT |
COMPLETED
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
7. If "yes" to either item 7a or 7b specify location(s) and reason(s) why
8. Organization information available for this project:
a. Minimum # of employees: and Maximum # of employees:
b. Are employees regularly on your payroll: __yes __ no
c. Specify equipment available for this contract:
d. Estimate rate of progress (such as 2.0 acres per day):
1. Minimum progress rate: Maximum progress rate
9. List the experience of the principal individuals of your business
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
10. Information required to complete a responsibility determination if the apparent successful offeror.
a. Credit References
| Company Name/Address |
| Point of Contact |
| Telephone number |
| TYPE OF WORK |
b. Banking Information.
| Company Name/Address |
| Point of Contact |
| Telephone number |
| TYPE OF WORK |
11. REMARKS
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:
| Title: |
| Date: |
Attachment 04
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