Attachment 5 Experience Questionnaire.pdf

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

3. How many 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

AMOUNT

TYPE OF PROJECT DATE

COMPLETE

D

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 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):

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. 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:

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

SECTION A: CONTRACTOR INFORMATION

A. Contractor’s Name and Address: ________________________________________________

B. Point of Contact: ______________________________________________________________

C. Phone #: ____________________________________________________________________

D. Contract Number: ___________________ Contract Type: ____________________

E. Project Title: _________________________________________________________________

F. Period of Performance: _________________________________________________________

G. Brief Description/Scope of Services provided: _________________________________________

H. Authorization is hereby granted to provide the information requested in SECTION B of this questionnaire.

Signature of Authorized Contractor Representative Date

Printed Name and Title of Authorized Contractor Representative

RESPONDENT INFORMATION:

A. Name:______________________________________ B. Position:________________ C. Telephone Number:_____________________ Fax Number: ______________ D. Address:___________________________ E. Relationship and Time Involved with Contractor:___________________ F. Date Questionnaire Completed:_______________________

E VG S N M U

Excellent Very Good Satisfactory Neutral Marginal Unsatisfactory

CONTRACT PERFORMANCE

1. Working relationship with your Company E VG S N M U

2. Did the contractor provide experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements? If no, please explain.

Yes No N/A

3. Exhibited knowledge of and compliance with government (or other) regulations and industry standards

4. Did the contractor provide and properly maintain operational equipment throughout the term of the contract? If no, please explain.

5. Did the contractor demonstrate the ability to hire, maintain, and replace, if necessary qualified personnel during the contract? If no, please explain.

6. Does the contractor provide timely and accurate records? Yes No N/A

7. How well did the contractor comply with Environmental, Safety, health and security requirements

8 Would you award similar contracts to this contractor (If no, Please explain in remarks)

9. Contractor’s Overall Performance E VG S N M U

QUALITY OF SERVICE/CONTROL

1. Contractor’s accomplishment in meeting the quality standards E VG S N M U

2. Did the contractor provide an effective quality control plan or inspection procedures to meet contract requirements? If no, please explain.

3. Were there any issues with the contractor’s oversight or quality control? if yes, please explain.

3. Overall Quality of Service/Control E VG S N M U

TIMELINESS OF PERFORMANCE

1. Was the job/contract started and completed on time?. If not, explain Yes No N/A

2. Did the contractor have a system or method to track progress on all work in progress? Yes No N/A REMARKS: If additional remarks are necessary, please attach an additional sheet.