Experience Questionnaire.pdf

EXPERIENCE QUESTIONNAIRE

1. CONTRACTOR NAME, ADDRESS AMD PHONE#

2. SUBMITTED TO (Office Name & Address)

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 FIRM HAD AS A:

PRIME CONTRACTOR_________________ AND/OR SUB-CONTRACTOR_____________

6. LIST BELOW THE PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE YEARS:

CONTRACT

AMOUNT

TYPE OF PROJECT

DATE

COMPLETED

NAME,ADDRESS,&PHONE OF OWNER /PERSON TO

CONTACT FOR PROJECT INFORMATION

7. LIST BELOW ALL OF YOUR CONTRACTUAL COMMITMENTS RUNNING CONCURRENTLY WITH THE

WORK CONTEMPLATED BY THIS PROJECT:

CONTRACT

NUMBER

AMOUNT

OF

AWARD

NAME, ADDRESS & PHONE # OF BUSINESS/GOVERNMENT

AGENCY INVOLVED

AWARDED

(UNITS)

PERCENT

COMPLETED

DATE

COMPLETED

8a. HAVE YOU EVER FAILED TO COMPLETE ANY WORK AWARDED TO YOU? ______YES _____NO

8b. HAS WORK EVER BEEN COMPLEED BY PERFORMANCE BOND? ______YES _____NO

8c. IF “YES” TO EITHER ITEMS SPECIFY LOCATION(S) AND REASON(S)WHY:

EXPERIENCE QUESTIONNAIRE PAGE 2

9. ORGANIZATION AND WORKERS THAT WILL BE AVAILABLE FOR THIS PROJECT:

a. MINIMUM NUMBER OF EMPLOYEES:___________ AND MAXIMUM NUMBER OF EMPLOYEES:__________

b. ARE EMPLOYEES REGULARLY ON YOUR PAYROLL? ______YES _______ NO

c. SPECIFY EQUIPMENT AVAILABLE FOR THIS CONTRCT:__________________________________________

10. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR BUSINESS:

INDIVIDUAL’S NAME

PRESENT

POSITION

YEARS

OF EXP. MAGNITUDE AND TYPE OF WORK

11. REMARKS: SPECIFY BOX NUMBERS (Attach sheets if extra space is needed to fully answer any of the above questions):

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.

12a. CERTIFYING OFFICIAL’S NAME AND TITLE

12b. SIGNATURE 12c. DATE