ATCH 3 RCW_EXPERIENCE_QUESTIONNAIRE_2012.docx
DOCX document 21 KB Posted
- Attached to
- RCW HABITAT AND CLUSTER IDIQ Federal contract opportunity
- Solicitation number
- AG-4660-S-12-0022
- Issued by
- Department of Agriculture Forest Service
About this file
ATch 3 Experience Questionaire
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| amend 1.pdf | ||
| ATCH 2 Appendix B-Map of RCW Compartmetns.pdf | ||
| AG-4660-S-12-0022.docm | DOCM document | |
| ATCH 2 Appendix A-Map of RCW Stands.pdf | ||
| ATch 5.doc | DOC document | |
| ATCH 4 DOL.mht | MHT file | |
| ATCH 1 RCW_SCOPE OF WORK_FY12_20120603.docx | DOCX document |
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Text version
ATTACHMENT 3
EXPERIENCE QUESTIONAIRE
Instructions: See Box 13, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.
1. Contractors Name, Address & Telephone No.
2. Type of Business __Company __Co-Partner __Corporation __Individual __Non-profit
Permit
3. Federal Fish and Wildlife Permit Information. (Please provide copy)
Permit No. _________________________________ Name as it appears on Permit: ________________________________
Expiration Date: _________________________________________ States Authorized to work: _______________
Activities Authorized for: _______________
Date of Birth: ______________________ Or Social Security Number: _______________________________________
4. How many years experience do you have in inspecting Red-cockaded woodpecker (RCW) cavities? ____Yrs
5. How many RCW cavities have you inspected or monitored? ____Cavities
6. How many years experience do you have surveying for RCW cavity trees? ____Yrs
7. How many years experience as a prime contractor_____ subcontractor___? If subcontractor who was the prime contractor:
CURRENT/PAST CONTRACT INFORMATION
8. List the projects your business has completed in the last 3 years similar in size and scope.
CONTRACT
NUMBER/
AMOUNT
| Description of RCW Activities (Number of cavities inspected) |
| PERIOD OF PERFORMANCE |
| NAME, ADDRESS & TELEPHONE NO. TO CONTACT FOR INFORMATION |
9. TRAINING INFORMATION:
a. TRAINING COURSES FOR CAVITY INSPECTION:
b. ARE YOU USDA FOREST SERVICE CERTIFIED TO CLIMB TREES:_________YES __________NO
c. STANDARD OPERATING PROCEDURES FOR RCW CAVITY INSPECTION PROJECTS:
10. EQUIPMENT: (i.e. CLIMBING LADDERS, VIDEO PROBE, TRANSPORTATION, SAFETY EQUIPMENT, SUPPLIES , ETC.
a. LIST EQUIPMENT:
b. CONDITION OF EQUIPMENT TO BE USED TO PERFORM CONTRACT:
c. STANDARD OPERATION PROCEDURES FOR KEEPING EQUIPMENT OPERATIONAL DURING RCW CAVITY INSPECTION OPERATIONS:
11. WORK FORCE:
a. Minimum No. of employees: and Maximum No. of employees
b. How will you recruit and train employees to ensure you will retain a sufficient experienced work force.
12. KEY PERSONNEL. List the experience of the key personnel (foreman, inspector, operators)performning on this contract and business.
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TRAINING |
12. Have you ever failed to complete any work awarded to you? __yes __ no
. If "yes" please explain
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: |
File details come from the government source that posted it. Updated .