B08_Attachment_5_140P8423Q0023_Operator_Experience.docx

Operator Experience form READ CAREFULLY: The purpose of this form is for the quoter to list the experience of all proposed equipment operators as described in Section L of the Solicitation.

All equipment operators are required to meet the minimum experience qualifications as outlined in Specifications Section 31 00 00 (Part 3). Refer to the Specifications for the required number of hours and other requirements.

Name of Contractor/Offeror:

Name of PROPOSED SUB-Contractor (IF APPLICABLE):

equipment & OPERATOR INFORMATION:

Equipment Type (dozer, excavator, etc.):

Size class (in thousands of pounds):

Operator Name:

Operator Company:

Note: Name listed for each reference should include agency, group, organization, or individuals for whom rehabilitation work was performed. Current phone number must be listed for reference such as project supervisor (or other person) familiar with the day-to-day equipment operation and the project’s outcome.

REFERENCE #1:

Name:

Position/Title:

Phone:

Organization:

Email:

Project Title:

Project Location:

Begin Date:

End Date:

Hours per day:

BREIF DESCRIPTION OF WORK:

REFERENCE #2:

Name:

Position/Title:

Phone:

Organization:

Email:

Project Title:

Project Location:

Begin Date:

End Date:

Hours per day:

REFERENCE #3:

Name:

Position/Title:

Phone:

Organization:

Email:

Project Title:

Project Location:

Begin Date:

End Date:

Hours per day:

REFERENCE #4:

Name:

Position/Title:

Phone:

Organization:

Email:

Project Title:

Project Location:

Begin Date:

End Date:

Hours per day:

Solicitation No. 140P8423Q0023 Page 1 of 1