Experience_Questionnaire_J5.doc

ATTACHMENT J.5

PAST PERFORMANCE QUESTIONNAIRE

1. CONTRACTOR NAME, ADDRESS, & TELEPHONE NUMBER

2. BUSINESS TYPE

[ ] COMPANY [ ] INDIVIDUAL

[ ] CORPORATION

[ ] CO-PARTNERSHIP

[ ] NON-PROFIT ORGANIZATION

3. HOW MANY YEARS DOES YOUR FIRM HAVE IN THE LINE OF WORK CONTEMPLATED BY THIS SOLICITATION?

4. HOW MANY YEARS EXPERIENCE IN CONTRACTING HAS YOUR BUSINESS HAD AS AN (a) PRIME CONTRACTOR __________ AND/OR (b) SUB-CONTRACTOR __________? IS THIS TIME CONCURRENT? ___________

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

CONTRACT

AMOUNT

COMPLETED

NAME, ADDRESS & TELEPHONE NUMBER OF

OWNER/PERSON TO CONTACT FOR INFO.

6. CONTRACT

NUMBER

DOLLAR AMT.

OF AWARD

NAME, ADDRESS & PHONE NO.

OF AGENCY INVOLVED

COMPLETED

UNITS

AWARDED

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 ITEM 7a OR 7b, SPECIFY LOCATION(S) AND REASONS(S) WHY:

(continued)

8. ORGANIZATION AND WORK THAT WILL BE AVAILABLE FOR THIS PROJECT:

a.(1) MINIMUM NO. OF EMPLOYEES: __________ AND a.(2) MAXIMUM NO. OF EMPLOYEES: __________

b. ARE EMPLOYEES REGULARLY ON YOUR PAYROLL: [ ] YES [ ] NO

c. SPECIFY EQUIPMENT AVAILABLE FOR THIS CONTRACT:

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

(1) MINIMUM PROGRESS RATE: __________ AND (2) MAXIMUM PROGRESS RATE: __________

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

POSITION

YEARS

OF EXP.

MAGNITUDE AND TYPE OF WORK

10. REMARKS – SPECIFY BOX NUMBERS (also use this area to address any problems with past performance not noted in item 7):

(attach sheets if extra space is needed)

11. THE BIDDER SHALL INDICATE WHETHER OR NOT HE/SHE HAS EXAMINED THE AREAS FOR WHICH THIS BID

IS SUBMITTED: [ ] YES [ ] NO

IF YES, THE DATE AREA WAS EXAMINED: _________________________

PERFORM THIS PROJECT.

12c. DATE