Attach_02_Exp_Quest.doc

AG-82CS-S-15-0002

San Juan National Forest BPA for Meeting Facilitation

ATTACHMENT 02 – TECHNICAL CAPABILITY/EXPERIENCE/PAST PERFORMANCE QUESTIONNAIRE

Instructions: See Box 10, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

1. Contractors Name, Address & Telephone No.

2. Type of Business __Company __Co-Partner __Non-profit __Corporation __Individual

3. Howmany years experience do you have in this line of work____Yrs

4. How many years experience as a prime contractor_____ subcontractor___

5. List any relevant projects your business has completed in the last 3 years

CONTRACT

NUMBER

6. Have you ever failed to complete any work awarded to you? __yes __ no

7. If "yes" to item 7 specify location(s) and reason(s) why

8. List the experience of the principal individuals of your business

9. EXPERIENCE STATEMENT: provide a qualification/experience statement from your firm which identifies the necessary skills and abilities of your key personnel relative to your experience with Federal Government entities and subject matter that is relevant to the planning, organizing, facilitating, and documenting meetings relevant to natural resource.

10. ADDITIONAL REMARKS:

CERTIFICATION: 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 Forest Service with any information needed to verify my capability to perform this project:

Name:

ATTACHMENT 02