Attch 3_ Experience Questionnaire.pdf

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

1. Contractors Name, Address & Telephone No. & Email 2. Type of Business

__Company __Co-Partner __Non-profit __Corporation __Individual

3. How many years experience do you have in this line of work____Yrs Total

4. How many years experience as a prime contractor_____ subcontractor___

5. List the projects your business has completed in the last 3 years

CONTRACT

NUMBER

AWARD

AMOUNT

NAME ADDRESS & PHONE

NO. TO CONTACT FOR INFO.

PERCENT

COMPLETED

DATE CONTRACT

COMPLETED

6. List all of your firms current contract commitments

CONTRACT

NUMBER

AWARD

AMOUNT

NAME ADDRESS & PHONE NO. TO CONTACT

FOR INFO.

PERCENT

COMPLETED

7. Have you ever failed to complete any work awarded to you? __yes __ no

If "yes" please specify location(s) and reason(s) why

IITF/Sabana Fire Alarms/Extinguishers Solicitation#: 12F43020Q0001 Attachment 3

8. Organization information available for this project:

a. Minimum # of employees: and Maximum # of employees:

b. Are employees regularly on your payroll: __yes __ no

c. Specify equipment available for this contract:

9. List the current experience of the principal individuals of your business/firm

INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK

10. REMARKS

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:

IITF/Sabana Fire Alarms/Extinguishers Solicitation#: 12F43020Q0001 Attachment 3