Experience Questionnaire.docx

DOCX document 76 KB Posted

Attached to
Generators Maintenance Service Federal contract opportunity
Solicitation number
12F43020Q0002
Issued by
Department of Agriculture Forest Service International Institute of Tropical Forestry Jardin Botanico Sur

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SOW Generators 2020.pdf PDF
12F43020Q0002.pdf PDF
SCA WD 15-5708.txt TXT text file

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Generators Preventive Maintenance, 12F43020Q0002

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 #, 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 workYrs
4. How many years of experience as a prime contractorYrs / subcontractor Yrs

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

WORK COMPLETED

DESCRIPTION OF WORK PERFORMED

6. List all of your firms current contract commitments CONTRACTPERCENT COMPLETED

NAME, ADDRESS, E-MAIL, & PHONE NO. TO CONTACT FOR INFORMATION.

AWARD AMOUNT

NUMBER

7a. Have you ever failed to complete any work awarded to you? yes no 7b. N/A

7c. If "yes" to either item 7a or 7b specify location(s) and reason(s) why

8. N/A

a. N/A

b. N/A

c. N/A

d. N/A

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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