Attachment 4 Experience Questionaire.docx

EXPERIENCE QUESTIONNAIRE INSTRUCTIONS:

If extra space is needed use the reverse. Mark "X" in appropriate boxes.

CONTRACTOR NAME, ADDRESS & TELEPHONE

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 you or your business had as a (a) prime contractor _____ and/or (b) sub-contractor _____?

List below the projects your business has completed within the last 3 years:

Contract Amount

Type of Project

Date Completed

Name, Address & Telephone No. of Person to Contact for Project Info.

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

Contract No.

$ Amt of ward

Name, Address & Phone No. of Business Govt./Agency

Awarded (Units)

% Completed

Date Contract Completed

Have you ever failed to complete any work awarded to you? Yes ( ) No ( ) Has work ever been completed by performance bond? Yes ( ) No ( )

If "Yes" to either item above specify location(s) and reason(s) why:

Organization and work that will be available for this project:

a. Minimum number of employees: ( ) and a Maximum number 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):

Minimum progress rate: __________ Maximum progress rate:

List below the experience of the principal individuals of your business

Individual's Name

Present Position

Years of Experience

Magnitude and Type of Work

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 (In Ink)

Date