AG-9702-S-10-0314_Present_Past Perf & Org Exp Questionnaire--7 Jul 10.doc
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- Attached to
- RECOVERY - Sespe Wilderness Trails Project, Los Padres National Forest (Ventura County, CA)
- Solicitation number
- AG-9702-S-0314
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Performance and Org Exp
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PRESENT/PAST PERFORMANCE & ORGANIZATIONAL EXPERIENCE QUESTIONNAIRE
SOLICITATION NO. AG-9702-S-10-0314
PROJECT TITLE: Recovery – Sespe Wilderness Trails Project, Los Padres National Forest (Ventura County)
1. CONTRACTOR/OFFEROR’S NAME, ADDRESS, & TELEPHONE NUMBER
2. BUSINESS TYPE
[ ] COMPANY [ ] INDIVIDUAL
[ ] CORPORATION
[ ] CO-PARTNERSHIP
[ ] NON-PROFIT ORGANIZATION
3. HOW MANY YEARS DOES YOUR BUSINESS HAVE IN THE LINE OF WORK AS REQUIRED BY THIS SOLICITATION?
4. HOW MANY YEARS EXPERIENCE IN CONTRACTING HAS YOUR BUSINESS HAD AS A PRIME CONTRACTOR AND/OR SUB-CONTRACTOR ? IS THIS TIME CONCURRENT? .
5. LIST BELOW THE SIMILAR (SCOPE, SIZE, COMPLEXITY) PROJECTS (NO MORE THAN SEVEN) YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE YEARS:
| CONTRACT NUMBER & AWARD AMOUNT |
| PROJECT LOCATION |
| PERFORMANCE PERIOD |
| NAME, ADDRESS & TELEPHONE NUMBER OF OWNER/PERSON TO CONTACT FOR INFORMATION |
6. LIST BELOW SIMILAIR (SCOPE, SIZE, COMPLEXITY) PROJECTS (NO MORE THAN SEVEN) YOUR BUSINESS IS WORKING ON CURRENTLY :
| CONTRACT NUMBER & AWARD AMOUNT |
| PROJECT LOCATION |
| PERFORMANCE PERIOD |
| NAME, ADDRESS & TELEPHONE NUMBER OF OWNER/PERSON TO CONTACT FOR INFORMATION |
7a. HAVE YOU EVER FAILED TO COMPLETE ANY WORK AWARDED TO YOU? [ ] YES [ ] NO
7b. HAVE YOU EVER RECEIVED LESS THAN SATISFACTORY PERFORMANCE RATINGS? [ ] YES [ ] NO
7c. IF "YES" TO EITHER ITEM 7a OR 7b, SPECIFY CONTRACT(S), REASON(S) AND PROVIDE NAME, ADDRESS & TELEPHONE NUMBER OF OWNER/PERSON TO CONTACT FOR INFORMATION:
(CONTINUED)
8. WORKERS AND/OR EQUIPMENT THAT WILL BE MADE 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
9. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR COMPANY:
| NAME (FIRST & LAST) |
| POSITION/TITLE |
| YEARS/MONTHS OF EXPERIENCE WITH COMPANY |
| MAGNITUDE OF PROJECTS/TYPE OF WORK |
10. ADDITIONAL REMARKS – REFERENCE SPECIFIC BOX NUMBERS:
| CERTIFICATION: I CERTIFY THAT ALL OF THE STATEMENTS MADE BY ME ARE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND |
| 11a. CERTIFYING OFFICIAL'S PRINTED NAME & TITLE |
| THAT ANY PERSON(S) NAMED AS REFERENCE(S) IS/ARE AUTHORIZED TO FURNISH THE USDA FOREST SERVICE WITH INFORMATION NEEDED TO VERIFY MY CAPABILITY |
| 11b. SIGNATURE (USE BLACK INK) |
X
| TO SUCCESSFULLY PERFORM THIS PROJECT. |
| 11c. DATE (MONTH/DAY/YEAR): |
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