Attachment No. 4 Contractor Questionnaire.docx

ATTACHMENT NO. 4 CONTRACTOR QUESTIONNAIRE

OFFERORS SHALL FURNISH THE FOLLOWING INFORMATION:

1. OFFEROR NAME, ADDRESS AND CONTACT INFORMATION

2. ARE YOU A LICENSED AND INSURED COMMERCIAL CONTRACTOR IN THE STATE OF VIRGINIA TO COMPLETE THE WORK REQUIRED UNDER THIS SOLICITATION?

___ YES or ___ NO (If yes, please list the applicable licenses, numbers and the type of insurance and amounts you carry.)

3. EXPERIENCE (Please furnish the following experience information):

a. How many years’ experience as a prime contractor do you have? _____ Years

b. How many years’ experience as a prime contractor do you have with similar projects including but not limited to construction, maintenance and repair of onsite sewage treatment systems, sand filter systems and manhole rehabilitation? ____ Years

c. Complete the information requested below showing a minimum of three projects completed within the past five years similar to or exceeding the work required to complete this project.

COMPLETED

NAME, EMAIL ADDRESS, AND TELEPHONE NO. OF PERSON TO CONTACT FOR PROJECT INFO.

4. Do you have a company employee safety plan available including elements of the work required to complete the contract? ____ YES or ____ NO

5. CERTIFICATION: I certify that the information listed above is 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.