Experience_Questionnaire_.pdf

Experience Questionnaire

CONTRACTOR NAME, ADDRESS, TELEPHONE, FAX, E-MAIL

SUBMITTED TO:

USDA Forest Service Chattahoochee-Oconee National Forest 1755 Cleveland Highway Gainesville, GA 30501

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

How many years experience in contracting have your or your business had as:

(a) a prime contractor __________ (b) a sub-contractor ____________

List below your most relevant projects completed within the past three years.

Use separate sheet for continuation.

AWARDING AGENCY/OWNER CONTRACT AMOUNT

PROJECT LOCATION DATE BEGUN

CONTRACT NUMBER DATE COMPLETED

CONTRACTING OFFICER NAME AND PHONE NUMBER

PROJECT ENGINEER/COR/COTR NAME AND PHONE NUMBER

BRIEF DESCRIPTION OF WORK (provide enough information to explain how the work relates to the current solicitation)

AWARDING AGENCY/OWNER CONTRACT AMOUNT

PROJECT LOCATION DATE BEGUN

CONTRACT NUMBER DATE COMPLETED

CONTRACTING OFFICER NAME AND PHONE NUMBER

PROJECT ENGINEER/COR/COTR NAME AND PHONE NUMBER

BRIEF DESCRIPTION OF WORK (provide enough information to explain how the work relates to the current solicitation)

AWARDING AGENCY /OWNER CONTRACT AMOUNT

PROJECT LOCATION DATE BEGUN

CONTRACT NUMBER DATE COMPLETED

CONTRACTING OFFICER NAME AND PHONE NUMBER

PROJECT ENGINEER/COR/COTR NAME AND PHONE NUMBER

BRIEF DESCRIPTION OF WORK (provide enough information to explain how the work relates to the current solicitation)

List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

Use separate sheet for continuation.

NAME, ADDRESS, AND TELEPHONE NUMBER OF BUSINESS OR

GOVERNMENT AGENCY

CONTRACT

NUMBER

DOLLAR

AMOUNT

PERCENT

COMPLETE

EXPECTED

COMPLETION

DATE

List below information for major subcontractors planned for this project.

NAME, ADDRESS, AND TELEPHONE NUMBER TYPE OF WORK DOLLAR AMOUNT

On a separate sheet provide a brief resume of principal individuals in your firm, including the proposed project manager and superintendent. Include at a minimum the individual’s name, present position, years of experience, years with your firm, and type of duties.

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.

CERTIFYING OFFICIAL’S NAME AND TITLE

SIGNATURE DATE