Attachment3.doc

Attachment 3

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 10, REMARKS, if extra space is needed to answer any items below. Mark "X" in the appropriate boxes.

Company Corporation Non-Profit Organization Co-Partner Individual

3. How many years experience do you have in this line of work? ________________ years

4. How many years experience as a prime contractor? _________ years subcontractor? ___________years

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

CONTRACT

AMOUNT

COMPLETED

NAME, ADDRESS & TELEPHONE NO. TO

CONTACT FOR INFORMATION

6. List all of your firms current contract commitments:

CONTRACT

NUMBER

AWARD

AMOUNT

NAME ADDRESS & PHONE NO.

FOR CONTACT INFORMATION

PERCENT

COMPLETED

DATE CONTRACT COMPLETED

FS6300-27

EXPERIENCE QUESTIONNAIRE CONTINUATION

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

7c. If "Yes" to either Item 7a or 7b specify location(s) and reason(s):

8. Organization that will be available 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):

Minimum progress rate: ________________ Maximum progress rate: ___________________

9. List the experience of the principal individuals of your business:

10. 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.

SIGNATURE TITLE DATE

FS 6300-27