Attachment_002_Experience_Questionnaire.pdf

EXPERIENCE

QUESTIONNAIRE

1. CONTRACTOR NAME, ADDRESS AMD PHONE#

2. SUBMITTED TO (Office Name & Address)

USDA Forest Service White River National Forest 900 Grand Ave Glenwood Springs, CO 81601

3. BUSINESS:

__Company _Co-partnership _Corporation

- Individual _Non-profit Organization

4. How many years do you or your firm have in the line of work contemplated by this solicitation?

5. HOW MANY YEARS EXPERIENCE IN CONTRACTING HAVE YOU OR YOUR FIRM HAD AS A:

PRIME CONTRACTOR AND/OR SUB-CONTRACTOR____________________

6. LIST BELOW THE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE YEARS:

CONTRACT

AMOUNT

TYPE OF

PROJECT

DATE

COMPLETED

NAME, ADDRESS, & PHONE OF OWNER PERSONS TO

CONTACT FOR PROJECT INFORMATION

7. LIST BELOW ALL OF YOUR CONTRACTUAL COMMITMENTS RUNNING CONCURRENTLY WITH THE

WORK CONTEMPLATED BY THIS PROJECT:

CONTRACT

NUMBER AMOUNT

OF AWARD

NAME, ADDRESS & PHONE # OF

BUSINESS/GOVERNMENT AGENCY

INVOLVED

AWARDED

(UNITS)

PERCENT

COMPLETED

DATE COMPLETED

Solicitation AG-82D7-S-16-0003 White River National Forest

Snow Removal and Lawn Care Services Aspen and Carbondale Administrative Sites

8a. HAVE YOU EVER FAILED TO COMPLETE ANY WORK AWARDED YOU?

YES NO

8b. HAS WORK EVER BEEN COMPLEED BY PERFORMANCE BOND?

YES NO

8c. IF "YES" TO EITHER ITEMS SPECIFY LOCATION(S) AND REASON(S) WHY:

9. ORGANIZATION AND WORKERS THAT WILL BE AVAILABLE FOR THIS PROJECT:

a. MINIMUM NUMBER OF EMPLOYEES:___ AND MAXIMUM NUMBER OF EMPLOYEES:

b. ARE EMPLOYEES REGULARLY ON YOUR PAYROLL? YES NO____________

c. SPECIFY EQUIPMENT AVAILABLE FOR THIS CONTRCT: __________________________________

d. ESTIMATE RATE OF PROGRESS BELOW (SUCH AS 2.0 ACRES/MAN/DAY):

MINIMUM PROGRESS RATE: AND MAXIMUM PROGRESS RATE: ___________

10. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR BUSINESS:

INDIVIDUAL'S NAME

PRESENT

POSITION

YEARS

OF EXP.

MAGNITUDE AND TYPE OF WORK

Solicitation AG-82D7-S-16-0003 White River National Forest

Snow Removal and Lawn Care Services Aspen and Carbondale Administrative Sites

11. REMARKS: SPECIFY BOX NUMBERS (Attach sheets if extra space is needed to fully answer any of the above questions):

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.

12a. CERTIFING OFFICIAL'S

NAME AND TITLE

l2b. SIGNATURE (Sign in Black Ink)

13. DATE