Contractor Questionaire.doc

DOC document 45 KB Posted

Attached to
RECOVERY - Boulder Creek Culvert Replacement
Solicitation number
AG-82B1-S-09-0035
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Experience Questionnaire

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USDA Forest Service

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 11, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.

1. Contractor Name, Address, and Telephone Number

2. Submitted to (Office Name and Address)

3. Business

[ ] Company [ ] Co-partnership

[ ] Corporation [ ] Individual

[ ] Non-profit Organization

4. How many years do you or your firm have in the line of work contemplated by this solicitation?

5. How many years experience have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?

6. List below the projects your business has completed within the last three years:

Contract Amount
Type of Project
Date Completed
Name, Address, and Telephone No. of Owner/Person to Contact for Project Information

7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

Contract Number
Dollar Amt. of Award
Name, Address, and Telephone No. of Business/Government Agency Involved
Awarded (Units)
Percent Completed
Date Contract Complete

8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No

8b. Has work ever been completed by performance bond? [ ] Yes [ ] No

8c. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No

8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:

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