Experience Questionaire - 04.pdf
PDF 274 KB Posted
- Attached to
- PINEVILLE, LA HAZ-MAT DISPOSAL
- Solicitation number
- 12456820Q0023
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| SF-30 Amendment 001.pdf | ||
| SOLICITATION BODY rev1.pdf | ||
| Wage Determination - 03.pdf | ||
| Statement Of Work - 01.pdf | ||
| SRS 4704 Chemical Disposal List - 02.xlsx | XLSX spreadsheet | |
| SF-1449 12456820Q0023.pdf |
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Text version
SOL NO. 12456820Q0023
HAZ-MAT DISPOSAL SERVICE
PINEVILLE, LA
ATTACHMENT 04
NAME, ADDRESS, E-MAIL, & PHONE NO. TO
CONTACT FOR INFORMATION.
AWARD
AMOUNT
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 of experience do you have in this line of work Yrs
4. How many years of experience as a prime contractor subcontractor
5. List no more than 5 most relevant projects your business has performed within 3 years of this solicitation issuance date:
CONTRACT
NUMBER
AWARD
AMOUNT
NAME, ADDRESS, E-MAIL, &
PHONE NO. TO CONTACT
FOR INFORMATION.
DATE
COMPLETED
DESCRIPTION OF
WORK PERFORMED
6. List all of your firms current contract commitments
NUMBER
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
PERCENT
COMPLETED
SOL NO. 12456820Q0023
HAZ-MAT DISPOSAL SERVICE
PINEVILLE, LA
ATTACHMENT 04
7c. If "yes" to either item 7a or 7b specify location(s) and reason(s) why
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:
d. Estimate rate of progress (such as 2.0 acres per day):
1. Minimum progress rate: Maximum progress rate
9. List the experience of the principal individuals of your business
INDIVIDUALS NAME PRESENT POSITION YRS EXP TYPE OF WORK
10. Information required to complete a responsibility determination if the apparent successful offeror.
a. Credit References Company Name/Address Point of Contact Telephone number TYPE OF WORK
b. Banking Information.
Company Name/Address Point of Contact Telephone number TYPE OF WORK
11. 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:
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