ExperienceQuestions_012910.docm

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.

Type of Project Dollar Amount Date Completed Customer/Reference Information Name Address Phone

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

Type of Equipment

Model Number/Size Overall 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 provide your valid State of Colorado Pump Installers License Number ______________________________________________________________

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.