B01_RFP_Attachment_J04_-_Specialized_Experience_Form_Construction.docx

DOCX document 19 KB Posted

Attached to
Crow Creek Reservation Water Main Replacement Federal contract opportunity
Solicitation number
19-102-SOL-00014
Issued by
Department of Health and Human Services Indian Health Service

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RFP Attachment J04 Specialized Experience Form

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16-161-SOL-00001

NCYRTC

Attachment J04 Company Specialized Experience – Construction Solicitation 102-19-SOL-00014

ATTACHMENT J04

COMPANY SPECIALIZED EXPERIENCE - CONSTRUCTION

Provide the following information to show examples of projects your company constructed within the last five (5) years indicating experience with projects of similar type and scope. Use one form per project.

Type of Project Represented Your Firm’s Name Name of Project Location of Project Owner General Scope of Construction Project Your Role (Prime, Joint Venture, or Subcontractor, etc.) and Work Your Company Self-Performed :

Construction Cost Extent and Type of Work Subcontracted Out Dates Construction: Began___________________ Completed______________ % Completed _______ Your Performance Evaluation by Owner, if known Were You Terminated or Assessed Liquidated Damages?

(If either is “Yes”, attach an Explanation) Owner’s Point of Contact for Reference (Name and Company) Current Telephone Number of Reference POC

SOURCE SELECTION SENSITIVE For Official Use Only Volume I – Factor 1 – Specialized Experience

FOR OFFICIAL USE ONLY, SOURCE SELECTION INFORMATION (FAR 3.104)

Response to Solicitation 102-19-SOL-00014

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