Attach. 11 Experience_Questionnaire.doc

Experience 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

Corporation Individual

Non-profit Organization

3. How many years experience do you have in this line of work? Years

4. How many years experience as a prime contractor? As a subcontractor?

5. Attach a list or list the projects your business has completed in the last 3 years:

6. List all of your firms current contract commitments:

Contract

Number Award

Amount Percent

Completion

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’ was checked to either item 7a or 7b, specifiy location(s) and reason(s) why:

8. Organization 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 contract:

d. Estimate rate of progress (Such as acres/day, miles/day, or other rate):

Minimum progress rate: Maximum progress rate:

9. List the experience of the prinicipal individuals of your business:

12. 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 capabilities to perform this project.