ExperienceQuestionnaire.docx

USDA Forest Service (3/03)

EXPERIENCE QUESTIONNAIRE

Instructions: Mark “x” in appropriate boxes. Attach sheets if extra space is needed to fully answer any questions.

1. Contractor Name, Address, Phone #, & Email Address

2. Submitted to (Office Name & Address) USDA Forest Service R1 AQM Idaho Montana Acquisition Team 3815 Schreiber Way Coeur d’Alene ID 83815

3. Business ☐ Company ☐ Corporation ☐ Partnership ☐ Individual

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

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

6. Relevant Experience/Past Performance: List below the projects your business has completed which are similar to this solicitation and the names of individuals who can comment on your performance of the work.

Contract Amount

Type of Project and Name of Business/Government Agency

Date Completed Name, Phone #, and/or Email Address of Owner/Person to Contact for Peformance Information

7. Concurrent Contractual Commitments: List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation.

Contract Amount

(Units) Percent Completed Date Contract Completed

8. Technical and Key Personnel available for this project:

a. (1) Minimum number of employees: (2) Maximum number of employees:

b. Are employees regularly on your payroll? ☐ Yes ☐ No

c. Identify equipment operators assigned to perform the work and their experience to meet the Government Requirements for this solicitation (see block 9).

d. Specify equipment available for this contract:

9. Employee’s Experience: List below the experience of the principal individuals of your business.

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.

10a. Certifying Official’s Name and Title: