EXPERIENCE QUESTIONNAIRE.doc
DOC document 41 KB Posted
- Solicitation number
- AG-5C16-S-10-0002
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Experience questionnaire
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| Construction and Material Specifications.doc | DOC document | |
| Bid Item 2 Ramsey Ballard Co Tree Planting map.JPG | JPG image | |
| Bid Item 1 Grassy Lake Ballard Co Tree Planting map.JPG | JPG image | |
| Bid Item 4 Swan Lake Ballard Co Tree Planting map.JPG | JPG image | |
| Bid Item 3 Robbins Tracy Hickman Co Location map.JPG | JPG image | |
| AG5C16S100002.pdf | ||
| Bid Item 2 Ramsey Ballard Co Location map.JPG | JPG image | |
| Solicitation Body_AG-5C16-S-10-0002 2 .rtf | RTF text file | |
| Wage Determination_sca.htm | HTM file | |
| Bid abstract from FY09 award.xls | XLS spreadsheet | |
| Bid Item 3 RobbinsTracy Hickman Co Tree Planting map.JPG | JPG image | |
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EXPERIENCE QUESTIONNAIRE
| 1. CONTRACTOR NAME, ADDRESS & PHONE |
| 2. SUBMITTED TO: (Office Name & Address) |
USDA-NRCS
Attn: Bruce Lawrence 771 Corporate Drive, Suite 210
Lexington, KY 40503-5479
| 3. BUSINESS |
| 4. Number of years firm has been in tree planting business: |
| 5. Number of years experience in contracting have you or your firm had as a: |
___Company
___ Individual ___Corporation
___Co-partnership
___ Non-profit Organization
| ______ Years |
| _____ Prime Contractor |
_____ Subcontractor
6. LIST BELOW THE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN LAST 3 YEARS.
| CONTRACT AMOUNT |
| TYPE OF PROJECT |
| DATE COMPLETED |
| NAME, ADDRESS & PHONE NO. OF OWNER/PERSON TO CONTACT FOR PROJECT INFORMATION |
7.LIST BELOW ALL OF YOUR CONTRACTUAL COMMITMENTS RUNNING CONCURRENTLY WITH THE WORK CONTEMPLATED BY THIS PROJECT:
| CONTRACT NUMBER |
| AMOUNT OF AWARD |
| NAME, ADDRESS & PHONE OF BUSINESS/GOVERNMENT AGENCY INVOLVED |
| AWARD DATE |
| PERCENT COMPLETE |
| DATE COMPLETED |
Experience Questionnaire
8. A. Have you ever failed to complete any work awarded to you? ___Yes ___No
B. Has work ever been completed by performance bond? ___ Yes ___No
C. If “Yes” to any items, specify locations and reasons why:
9. Workers that will be available for this project:
a. Minimum Number of employees: ____ Maximum number of employees_____
b. Are employees regularly on your payroll? ___Yes ___No
c. Length of time employees have been in your employment: ___ - ___ Years
d. Specify equipment available for this contract: ______________________
10. REMARKS: (If needed)
| CERTIFICATION |
| Certifying Official’s Printed Name and Title |
| 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 NRCS with any information needed to verify my capability to perform this project. |
| Signature (Sign in ink) and Date |
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