Attachment B Experience Questionnaire 2 Pages.rtf

ATTACHMENT NO. B

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.

2. Type of Business __Company __Co-Partner __Corporation __Individual __Non-profit

3a. How many years experience do you have in this line of work ____Yrs

3b. List your expertise in identification of plant species native to the oak, mixed oak-pine and mixed mesophytic hardwoods of eastern Kentucky, and native seed/cutting collection and processing and growing.

4. How many years experience as a prime contractor_____ subcontractor___

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

CONTRACT

AMOUNT

TYPE OF PROJECT

DATE

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. TO CONTACT FOR INFO.

PERCENT

COMPLETED

DATE CONTRACT

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 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:

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

INDIVIDUALS NAME

PRESENT POSITION

YRS EXP

TYPE OF WORK

10. METHOD TO ACCOMPLISH WORK – Describe your plan to execute the work and stay on schedule.

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:

NOTE: IF ADDITIONAL SPACE IS NEEDED FOR ANSWERS TO ANY ITEMS IN THIS QUESTIONNAIRE, YOU MAY USE BLANK SHEETS OF PAPER.