B01 Attachment J04 - Company Specialized Experience Construction Form_Rev.1 dated January 26, 2026.docx

This is a Company Specialized Experience - Construction Form template used as an evaluation criterion for the Zuni Quarters Sewer Improvement Project solicitation (75H70126R00014) issued by the Department of Health and Human Services Indian Health Service. The form requires contractors to demonstrate relevant construction experience by providing detailed information on up to six projects completed within the preceding six years.

Contractors must complete one form per project and provide: project type, firm name, project name and location, owner information, general scope of construction work, facility type, building size in gross square feet and number of stories, the firm's role (prime, joint venture, or subcontractor) and self-performed work scope, contract dollar value, extent and type of subcontracted work, construction dates and completion percentage, owner performance evaluations, any terminations or liquidated damages assessments, and owner reference contact information with current telephone numbers. This specialized experience documentation is designated as Source Selection Sensitive information for official use only and serves as Factor 1 in the proposal evaluation process. The most recent revision of this form is dated January 26, 2026, coinciding with the final proposal deadline of February 4, 2026, at 2:00 PM CST.