Attachment 2 - Experience Questionnaire.docx

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Attached to
ID_NV_UT OFF RANGE CORRALS Federal contract opportunity
Solicitation number
140L0120R0008
Issued by
Department of the Interior Bureau of Land Management National Office

About this file

This document is an experience questionnaire for contractors interested in providing off-range corral services for wild horses and burros in Idaho, Nevada, and Utah. The solicitation is being conducted by the Bureau of Land Management National Office under number 140L0120R0008. The experience questionnaire requests information on the contractor's years of experience, past similar projects completed in the last three years including contract amounts and references, any past failures to complete work or need for performance bonds, and experience of principal individuals to work on the project. Contractors must provide certification that the statements in the questionnaire are complete and correct.

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Text version

SOLICITATION NO 140L0120R0008

ATTACHMENT 2

CONTRACTOR EXPERIENCE QUESTIONNAIRE

OFF RANGE CORRALS

140L0120R0008

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 8, Remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

1. Contractors Representative 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 the Contract Representative has completed in the last 3 years:

Contract Amount
Type of Project
Date Completed
Name, Address, & Telephone no. to Contact for Information.
6a. Have contract representative ever fail to complete any work awarded to you?
[ ] Yes
[ ] No
6b. Has the contract representative work ever been completed by performance bond?
[ ] Yes
[ ] No

6c. If ‘Yes’ was checked to either item 6a or 6b, specify location(s) and reason(s) why:

7. List the experience of the principal individuals that will be working on this project

Individuals Name
Present Position
Years of Experience
Type of Work

8. 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.

Printed Name
Signature
Title
Date

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