Exp. Qstnr.doc.docm

EXPERIENCE & PAST PERFORMANCE QUESTIONNAIRE

AG-82B1-S-10-0235

Name of Contractor: ________________________

Please provide information that is relevant to this project.

Please list in the table below your relevant work experience over the last three years. Provide references that can confirm your experience with the work outlined in the plans and specifications.

Project Description

Dollar Amount

Year Customer/Reference Information Provide current contact information Name Address Telephone

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 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.

Note: Answer all questions. Failure to provide responses or inaccurate information for the above-requested items may result in a bid being deemed “Non-responsive” and excluded from further consideration.