Attachment 5 - Experience_Questionnaire.docx
DOCX document 24 KB Posted
- Solicitation number
- 12444522Q0053
- Issued by
-
Department of Agriculture Forest Service
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 3 - Maps - MIO_FY22_Combined Marking Contract.pdf | ||
| 12444522Q0053.docx | DOCX document | |
| Attachment 2 - Mio_FY22_SpecificationsOfWork.docx | DOCX document | |
| Attachment 1 - Schedule of Items - MIO.xlsx | XLSX spreadsheet | |
| Attachment 4 - Wage Determination.docx | DOCX document |
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Attachment 5 - Experience Questionnaire
HURON-MANISTEE NF / MIO RD TIMBER MARKING
MIO FY22 Timber Marking Contract
EXPERIENCE AND CAPABILITY QUESTIONNAIRE
Instructions: See Box 10, REMARKS, if extra space is needed to answer any items below. Mark "X" in the appropriate boxes. Please list NA for inapplicable items.
| 1. Contractor's Name, Address & Telephone Number |
| 2. Type of Business |
____ Company
____ Corporation
____ Non-profit Organization
____ Co-partner
____ Individual
3. How many years of experience do you have in this line of work? ___________________
4. How many years of experience as a prime contractor? _________ subcontractor? ________
5. List the projects your business has completed in the last 3 years.
Contract Amount
| Type of Project |
| Date |
Completed Name and Telephone Number to Contact For Information
6. List all of your firm's current contract commitments.
Contract Number Contract Amount
| Type of Project |
| Est. Date of |
Completion Name and Telephone Number to Contact For Information
7a. Have you ever failed to complete any work awarded to you? ____ yes ____ no 7b. Have you ever failed to complete any work awarded to you by the original Contract completion date?
____ yes ____ no 7c. Has work ever been completed by performance bond? ____ yes ____ no 7d. If "yes" to either Question 7a. or 7b., please specify location(s) and reason(s):
8. Organization that will be available for this project:
| a. | Minimum No. of employees: _______________ Maximum No. of employees: ________________ |
| b. | Are employees regularly on your payroll? ____ yes ____ no |
| c. | If applicable, specify equipment available for this contract: |
d. If applicable, estimate rate of progress (such as 2.0 acres per day):
Minimum progress rate: __________________________ Maximum progress rate: ______________________
9. List the experience of the principal individuals who will complete this project.
| Individual's Name |
| Present Position |
| Years Experience |
| Type of Work |
10. Remarks: Additional pages may be added to provide additional information in this section.
Please include a list of bio-based product if they will be used in performance of this contract. Applicable bio-based products may include fuel, lubricants, or additives for vechicals or equipment provided by the contractor.
CERTIFICATION: I certify that all of the statements made above 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.
Signature Title Date
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