Attachment 6 - Experience Questionnaire.docx
DOCX document 20 KB Posted
- Solicitation number
- 12444522Q0047
- Issued by
-
Department of Agriculture Forest Service
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| File | Type | Posted |
|---|---|---|
| SF30 Amend1 12444522Q0047 s.pdf | ||
| Attachment 5 - Wage Determination.docx | DOCX document | |
| Attachment 3 - Vicinity Map.pdf | ||
| Attachment 2 - Statement of Work_HRRA.docx | DOCX document | |
| 12444522Q0047.docx | DOCX document | |
| Attachment 1 - Schedule of Items_HRRA.doc | DOC document | |
| Attachment 4 - Maps.pdf |
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Attachment 6 – Experience Questionnaire
EXPERIENCE QUESTIONNAIRE
1. Contractor’s Name, Address & Telephone #.
2. Type of Business:
___Company ___Co-Partner ___Corporation ___Individual ___Non-profit Organization
| 3. How many years’ experience do you have related to this line of work? _______ years |
| 4. How many years’ experience as a prime contractor? ________years |
Subcontractor? _______
5. List all the similar projects your business has completed in the last three (3) years.
| CONTRACT AMOUNT |
| TYPE OF CONTRACT WORK |
| DATE COMPLETED |
| Contact Name, Address and Tele. # |
6. List all of your firms’ current contract commitments
| CONTRACT NUMBER |
| AWARD AMOUNT |
| Contact Name, Address & Tele. # |
| Percent Completed |
| Date Contract Completed |
| 7a. Have you ever failed to complete any work awarded to you? | ___yes | ___no | ||
| 7b. Has work ever been completed by performance bond? | ___yes | ___no |
7c. If “yes” to either item 7a or 7b above, specify reason(s) and location(s) why.
8. Organization structure that will be available for this project:
| a. Minimum No. of employees: _____ | and Maximum No. of employees:_____ | ||
| b. Are employees regularly on your payroll? | ___yes | ___no |
c. Specify equipment to be used for this contract:
d. Estimate rate of progress (exp. 100 feet, 1/8 mile a day, etc.…):
Minimum progress rate:____________ Maximum progress rate:____________
9. List the experience of the principal individuals of your business
| NAME |
| PRESENT POSITION |
| YRS EXP. |
| TYPE OF WORK |
10. GPS and Shapefile experience:
11. Work plan: Describe plan how to accomplish task.
UEI# (formerly Duns) __________________________
CERTIFICATION: I certify that all of the statements made by me are complete and correct to be 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 | Print or Typed Name/ Title | Date |
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