Experience Questionnaire.pdf

USDA Forest Service (1/00)

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 10, Remarks, if extra space is needed to answer any item below. Mark “x” in appropriate boxes.

1. Contractor Name, Address, and Telephone Number

2. Submitted to

Adam Redgrave adam.redgrave@usda.gov

3. Business Company Co-Partnership Corporation Individual Non-profit Organization

4. How many years do you or your firm have in the line of work contemplated by this solicitation?

5. How many years experience in contracting have you or your business had as a (a) prime contractor and/or (b) sub-contractor ?

6. List below the projects your business has completed within the last three years (or currently working) where we can confirm that your company has experience in similar work.

Contract Amount

Type of Project

Ongoing or Date

Completed

Name, Address, and Telephone No.

of Owner/Person to Contract for Project Information

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 7c. If “Yes” to either item 7a or 7b specify location(s) and reason(s) why:

8. List below the experience of individuals who will be working on site including supervisors:

Individual’s Name And City of Residence

Present Position Years of Exp.

Magnitude and Type of Work

9. Remarks—Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above questions):

10. 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.

11a.Certifying Official’s Name and Title

11b. Signature (Sign in Ink) 12. Date