ATCH_2_Experience_Questionnaire.docx

DOCX document 20 KB Posted

Attached to
Off Range Holding Federal contract opportunity
Solicitation number
L15PS00182
Issued by
Department of the Interior Bureau of Land Management Eastern States

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Experience Questionaire

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Sol_L15PS00182_Amd_000002.pdf PDF
Sol_L15PS00182_Amd_000001.pdf PDF
ATCH_3__Fin_Institution.docx DOCX document
Sol_L15PS00182.pdf PDF
ATCH_1_Past_Performance.doc DOC document

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SOLICITATION NO L15PS00182

ATTACHMENT 2

CONTRACTOR EXPERIENCE QUESTIONNAIRE

OFF RANGE PASTURES_ HOLDING

L15PS00182

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 8, Remarks, if extra space is needed to answer any item below. Mark X in the appropriate boxes.

1. Contractors Representative Name, Address, & Telephone No.

2. Type of Business:

[ ] Company [ ] Co-Partner [ ] Corporation [ ] Individual [ ] Non-profit Organization

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

4. How many years’ experience as a prime contractor? [ ] As a subcontractor? [ ]

5. Attach a list or list the projects the Contract Representative has completed in the last 3 years:

Contract Amount
Type of Project
Date Completed
Name, Address, & Telephone no. to Contact for Information.
6a. Have contract representative ever fail to complete any work awarded to you?
[ ] Yes
[ ] No
6b. Has the contract representative work ever been completed by performance bond?
[ ] Yes
[ ] No

6c. If ‘Yes’ was checked to either item 6a or 6b, specify location(s) and reason(s) why:

7. List the experience of the principal individuals that will be working on this project

Individuals Name
Present Position
Years of Experience
Type of Work

8. 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 capabilities to perform this project.

Printed Name
Signature
Title
Date

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