Attach_03_Exp_Quest.doc
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- Attached to
- San Juan Public Lands Center Janitorial
- Solicitation number
- AG-82CS-S-15-0005
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Fillable Attachment 3
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| File | Type | Posted |
|---|---|---|
| Amendment_0001.pdf | ||
| Attach_01.xlsx | XLSX spreadsheet | |
| AG-82CS-S-15-0005.pdf |
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AG-82CS-S-15-0005
San Juan Public Lands Center Janitorial Services
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 11, 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 contractpr_____ subcontractor___
5. List the projects your business has completed in the last 3 years
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO. |
| PERCENT |
COMPLETED
DATE CONTRACT
COMPLETED
6. List all of your firms current contract commitments
CONTRACT
NUMBER
AWARD
AMOUNT
| NAME ADDRESS & PHONE NO. TO CONTACT FOR INFO. |
| PERCENT |
COMPLETED
7. Have you ever failed to complete any work awarded to you? __yes __ no
If "yes" specify location(s) and reason(s) why
8. Organization information available for this project:
a. Minimum # of employees: and Maximum # of employees:
b. Are employees regularly on your payroll: __yes __ no
c. Specify equipment available for this contract:
9. List the experience of the principal individuals of your business
| INDIVIDUALS NAME |
| PRESENT POSITION |
| YRS EXP |
| TYPE OF WORK |
10. 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:
| Title: |
| Date: |
ATTACHMENT 03
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