Exp. Qstnr.doc

EXPERIENCE QUESTIONNAIRE

Name of Contractor: __________________________

Please provide information that is relevant to this project.

Please list in the table below your work experience over the last three years.

Amount Date

Completed Customer/Reference Information

Name Address Phone

Please list in the table below the equipment that will be utilized on this project.

Condition Owned or Rented

Please answer the following questions.

· How many years experience do you have with this type of work? ___________________________________

· Do you have any other contractual commitments that may run concurrently (if awarded a contract) under this solicitation? _________________

· If the answer to the above is yes, please list these projects here.______________________________________________________________

Please complete the following table for the employees that will be working on this project.

Employee

Name Employee

Classification Employment Status

Permanent OR Seasonal

Qualified?

· Have you ever been defaulted on any Federal Government contract? ______________________

· If the answer to the above is yes, explain the circumstances and list the name of the Contracting Officer.