Attachment 5 Appendix E.docx
DOCX document 29 KB Posted
- Solicitation number
- AG-82X9-S-11-0015
- Issued by
-
Department of Agriculture Forest Service
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Attachment 5 Appendix E Experience and Capability Questionnairre
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| File | Type | Posted |
|---|---|---|
| Attachment 9 Q and A.docx | DOCX document | |
| Attachment 7 NEIS Information.PDF | ||
| Attachment 8 Drawings.PDF | ||
| Amendment Two.pdf | ||
| Attachment 1 Appendix A Revised.docx | DOCX document | |
| Amendment One.pdf | ||
| Attachment 2 Appendix B .docx | DOCX document | |
| Attachment 4 Appendix D.docx | DOCX document | |
| Attachment 6 Wage Determination.PDF | ||
| Return This Copy.PDF | ||
| Attachment 1 Appendix A.docx | DOCX document | |
| Attachment 3 Appendix C.docx | DOCX document | |
| Keep This Copy.PDF |
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Text version
Janitorial Services for the Supervisor’s Office & Laramie R.D. Office Medicine Bow & Routt N.F. & Thunder Basin N.G.
Solicitation No. AG-82X9-S-11-0015
APPENDIX E
EXPERIENCE AND CAPABILITY QUESTIONNAIRE -- OMB Clearance Number 9000-0142 Instructions: See Box 10, REMARKS, if extra space is needed to answer any items below. Mark "X" in the appropriate boxes. Please list NA for inapplicable items.
| 1. Contractor's Name, Address & Telephone Number |
| 2. Type of Business |
| |_| Company |
| |_| Corporation |
| |_| Non-profit Organization |
| |_| Co-partner |
| |_| Individual |
3. How many years of experience do you have in this line of work?
4. How many years of experience as a prime Contractor? subContractor?
5. List the projects your business has completed in the last 3 years.
Contract Amount
| Type of Project |
| Date |
Completed Name and Telephone Number to Contact For Information
6. List all of your firm's current contract commitments.
Contract Number Contract Amount
| Typeof Project |
| Est. Date of |
Completion Name and Telephone Number to Contact For Information
7a. Have you ever failed to complete any work awarded to you? |_| yes |_| no 7b. Has work ever been completed by performance bond? |_| yes |_| no 7c. If "yes" to either Question 7a. or 7b., please specify location(s) and reason(s):
EXPERIENCE AND CAPABILITY QUESTIONNAIRE -- OMB Clearance Number 9000-0142
8. Organization that will be available for this project:
| a. | Minimum No. of employees: Maximum No. of employees: |
| b. | Are employees regularly on your payroll? |_| yes |_| no |
| c. | If applicable, specify equipment available for this contract: |
d. If applicable, estimate rate of progress (such as 2.0 acres per day):
Minimum progress rate: Maximum progress rate:
9. List the experience of the principal individuals of your business.
| Individual's Name |
| Present Position |
| Years Experience |
| Type of Work |
10. Remarks:
CERTIFICATION: I certify that all of the statements made above are complete and correct to the best of my knowledge and that ny persons named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.
Signature Title Date
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