Experience_Questionnaire.pdf

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

Company Corporation Non-profit Org Co-partner Individual

3. How many years experience do you have in this line of work? Years

4. How many years experience as a prime contractor? Years

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

6. List all of your firms current contract commitments:

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 locations and reason why:

CONTRACT

NUMBER

AWARD

AMOUNT

NAME, ADDRESS, & PHONE NO.

TO CONTACT FOR INFORMATION

PERCENT

COMPLETED

DATE

COMPLETED

Telephone No.:

Address:

Name:

SAM DUNS No:

CONTRACT

AMOUNT

TYPE OF

PROJECT

DATE

COMPLETED

NAME, ADDRESS & TELEPHONE NO.TO

CONTACT FOR INFORMATION

EXPERIENCE QUESTIONNAIRE

Instructions: This form may be completed manually or by using MS Excel. See Box 11, remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

8. Organization that will be available for this project:

a. Minimum No. of employees: and maximum No. of employees:

b. Are employees regularly on your payroll? Yes No

c. Specify equipment available for this project:

9. List the experience of principal individuals with proper qualifications/certifications to be used on this project:

10. Financial Responsibility:

(in lieu of this, you may submit a letter from your financial institution that addresses the status and standing of your accounts)

Name of Financial Institution

Address:

Contact Name

Contact Phone Nbr

11. Remarks

INDIVIDUALS

NAME

YEARS

EXPERIENCE TYPE OF WORK

PRESENT

POSITION

SIGNATURE TITLE DATE

CERTIFICATION: I certify that I intend to complete the project as specified and that my offer conforms to the specifications of the solicitation without deviation unless I provide an alternative proposal. All 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 National Park Service with any information needed to verify my capability to perform this project.

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