ATTACHMENT 2 - Experience Questionnaire.pdf
PDF 136 KB Posted
- Attached to
- Janitorial Services at National Seed Laboratory
- Solicitation number
- 1243ZP20R0014
- Issued by
-
Department of Agriculture Forest Service
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT 3 - SCA WD 15-4487 Rev 11.pdf | ||
| ATTACHMENT 1 - Scope of Work.pdf | ||
| 1243ZP20R0014_SF-1442.pdf | ||
| 1243ZP20R0014 Combined Synopsis-Soliciation.pdf |
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1243ZP20R0014, JANITORIAL SERVICES
Attachment 2 - Page 1 of 4
ATTACHMENT 2
EXPERIENCE QUESTIONNAIRE
Instructions: See Box 8, remarks, if extra space is needed to answer any item below. Additional sheets may be attached.
1. Contractors Name, Address & Telephone No.
2. Type of Business
__Company __Co-Partner __Non-profit
__Corporation __Individual
3. How many years of experience do you have in this line of work____ Years
4. How many years of experience as a prime contractor_____ subcontractor___
5. LIST OF PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST 5 YEARS
NOTE: The description of work performed should be in sufficient detail for the Government to determine what the work included. (i.e. floor maintenance, dusting, washing walls, washing windows and doors, vacuuming carpets, air vents cleaning, cleaning bathrooms or other similar work accomplished). Use of only a project title does not usually provide enough detail for the Government to make an evaluation.
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Services (refer to note in No. 5 above )
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Services (refer to note in No. 5 above )
Attachment 2 - Page 2 of 4
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Services (refer to note in No. 5 above )
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Services (refer to note in No. 5 above )
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Services (refer to note in No. 5 above )
Attachment 2 - Page 3 of 4
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Services (refer to note in No. 5 above )
Project & Location ___________________________________________________________________________________
Contract Number:_______________________________ Award Amount: _____________________________________
Period of Performance and/or completion date: _____________________________________________________________
Client/Company’s Name/Address: ________________________________________________________________________
Contact Name and Telephone number: ____________________________________________________________________
Description of Services (refer to note in No. 5 above )
6c. If "yes" to either item 6a or 6b specify location(s) and reason(s) why
Attachment 2 - Page 4 of 4
7. List the experience of the primary individuals to perform on proposed project
INDIVIDUALS NAME PRESENT POSITION DEGREE/YRS EXP TYPE OF WORK
8. CERTIFICATIONS/ SPECIAL QUALIFICATIONS (Attach Certificates/Documentation)
9. REMARKS (Additional sheets may be attached to the experience questionnaire)
NOTE OTHER SHEET MAY BE ATTACHED TO SUPPLEMENT THIS INFORMATION.
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:
Name: Title: Date:
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