EXPERIENCE QUESTIONAIRE

CHIPPEWA NF – BLACKDUCK

JANITORIAL

Experience Questionnaire

(Please complete and submit the following with your offer.) By submitting the offer, the Contractor agrees to all terms, conditions, clauses, and provisions included in the solicitation and agrees to furnish any awarded items at the price set in the schedule. The offer is valid for 60 after the closing date of the solicitation unless a formal extension is granted by the contractor.

OFFEROR NAME

OFFEROR SAM UEI NUMBER

OFFEROR EMAIL ADDRESS

OFFEROR POINT OF CONTACT (NAME AND PHONE)

Instructions: See Box 10, REMARKS. If extra space is needed to answer any items below. Mark "X" in the appropriate boxes.
Please list NA for inapplicable items.
1. Contractor's Name, Address & Telephone Number

2. Type of Business

Company
Corporation
Non-profit Organization
Co-partner
Individual

3. How many years of experience do you have in this line of work? 4. How many years of experience as a prime contractor?

subcontractor?

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

Contract
Amount

Type of Project

Date
Completed

Name and Telephone Number to Contact
For Information

CHIPPEWA NF – BLACKDUCK

JANITORIAL

6. List contractual commitments running concurrently with the work contemplated by this soliciation.

Contract
Number

Contract
Amount

Type of Project

Est. Date of
Completion

7a. Have you ever failed to complete any work awarded to you? 7b. Has work ever been completed by performance bond?

Name and Telephone Number to
Contact For Information

yes
yes

no
no

7c. If "yes" to either Question 7a. or 7b., please specify location(s) and reason(s): 8. List any special features of the supply reuqired for effective program performance.

9. Provide information on the probable life of the items selected in comparison to unchosen compatible items.

10. Provide warranty information and the avialability of maintenance and repair.

11. Detail delivery terms.

12. Organization that will be available for this project: a.

Minimum No. of employees:

Maximum No. of employees:

b.

Are employees regularly on your payroll?

yes

c.

Specify supplies, tools, equipment (list model, horsepower, and pice size capabilities), and facilities to be used for this contract:

d.

If applicable, estimate rate of progress (such as 2.0 acres per day):

Minimum progress rate:

no

Maximum progress rate:

CHIPPEWA NF – BLACKDUCK

JANITORIAL

13. List the employees that would be assigned to perform vehicle upfitting services at the work site on this