A10 Attachment 1 Company Specialized Experience Form.docx
DOCX document 18 KB Posted
- Attached to
- OEHE GIS Support Services IDIQ
- Solicitation number
- 75H70125R00030
About this file
This is a specialized experience form template that contractors must complete to demonstrate their past performance and capabilities for an Indian Health Service (IHS) Geographic Information Systems (GIS) support services IDIQ opportunity. The form requires companies to provide their basic information including SAM UEI number, small business status, and intent to bid, followed by detailed information for 2-5 relevant projects completed within the last 6 years that are at least 75% construction complete.
The template includes sections for each project's contract details (contract number, value, location, period of performance), scope description, and references. It concludes with a questionnaire asking companies to explain which tasks from the sources sought they can perform directly, which would require subcontracting, any tasks they cannot perform, and any ambiguous requirements. This form appears to be Attachment 1 referenced in the associated sources sought notice for GIS support services, which seeks small business capabilities including Indian Economic Enterprises, 8(a), HUBZone, WOSB, SDVOSB and other socioeconomic categories.
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Other files
| File | Type | Posted |
|---|---|---|
| A10 Attachment 2 IHS IEE Representation Form_Jan 2022.pdf |
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Text version
Specialized Experience Form Company Information
Company Name
Website
Physical Address
SAM UEI Number
Small Business Status (e.g. small business, small disadvantaged business, Woman owned small business, Indian Economic Enterprise, etc.)
Will your firm submit a proposal if solicitation is issued? Yes or No
Specialized Experience
In accordance with Section L, submit projects at least 75% construction complete or completed within the last six (6) years that are similar in scope to the requirements of the project solicitation. Submit at least two (2) but no more than five (5) examples.
PROJECT 1 Name / Contract No.
Prime or Subcontractor?
Period of Performance
Contract Value
Contract Location
Contract Completion Date
| Description of Scope Performed and Complexity |
| (expand as needed) |
Federal, State, Tribal, or Other?
Project Reference(s)/Agency Point of Contact (Title, Name, Phone, Email)
PROJECT 2 Name / Contract No.
Prime or Subcontractor?
Period of Performance
Contract Value
Contract Location
Contract Completion Date
| Description of Scope Performed and Complexity |
| (expand as needed) |
Federal, State, Tribal, or Other?
Project Reference(s)/Agency Point of Contact (Title, Name, Phone, Email)
PROJECT 3 Name / Contract No.
Prime or Subcontractor?
Period of Performance
Contract Value
Contract Location
Contract Completion Date
| Description of Scope Performed and Complexity |
| (two projects required, delete or expand as needed) |
Federal, State, Tribal, or Other?
Project Reference(s)/Agency Point of Contact (Title, Name, Phone, Email)
PROJECT 4 Name / Contract No.
Prime or Subcontractor?
Period of Performance
Contract Value
Contract Location
Contract Completion Date
| Description of Scope Performed and Complexity |
| (two projects required, delete or expand as needed) |
Federal, State, Tribal, or Other?
Project Reference(s)/Agency Point of Contact (Title, Name, Phone, Email)
PROJECT 5 Name / Contract No.
Prime or Subcontractor?
Period of Performance
Contract Value
Contract Location
Contract Completion Date
| Description of Scope Performed and Complexity |
| (two projects required, delete project or expand as needed) |
Federal, State, Tribal, or Other?
Project Reference(s)/Agency Point of Contact (Title, Name, Phone, Email)
Questionnaire
| Number |
| Question |
| Response |
| 1 |
| Which tasks outlined in the sources sought would your company directly be able to perform? Please explain. |
| Expand as needed |
| 2 |
| Which tasks outlined in the sources sought would your organization need to subcontract? Please explain |
| Expand as needed |
| 3 |
| Are there any tasks that your company would be unable to perform or would be unable to subcontract? Please explain |
| Expand as needed |
| 4 |
| Are there any components of this sources sought that are ambiguous or written in such a way that meeting requirements would be challenging? Please explain. |
| Expand as needed |
File details come from the government source that posted it. Updated .