ATT5_EXP_QUEST.doc
DOC document 58 KB Posted
- Solicitation number
- AG-4660-S-16-0003
- Issued by
-
Department of Agriculture Forest Service
About this file
Experience Questionnaire
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Text version
SOLICITATION AG-4660-S-16-0003
RED COCKADED WOODPECKERS
SAVANNAH RIVER SITE
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark ‘X’ in the appropriate boxes.
1. Contractor’s 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 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
8. Organization that will be availble for this project:
a. Minimum No. of employees: and Maximum No. 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 5
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