A10 Attachment 1 SS Submittal Questionnaire.docx
DOCX document 18 KB Posted
- Attached to
- Kayenta Staff Quarters Abatement and Demolition
- Solicitation number
- 75H70123R00063
About this file
This document contains a sources sought questionnaire and description of a federal contract opportunity for abatement and demolition services. The Indian Health Service is seeking information from small businesses including Native American/Indian-owned, 8(a), HUBZone, women-owned, veteran-owned, and small disadvantaged businesses to conduct market research for an upcoming procurement. Interested firms must complete the sources sought questionnaire providing company and bonding information, as well as descriptions of up to three relevant past projects as a prime contractor or subcontractor. Responses are due by June 5, 2023. The anticipated contract value is between $1,000,000 and $5,000,000 to abate hazardous materials and demolish 27 abandoned staff quarters at the Kayenta Healthcare Center in Kayenta, Arizona within 180 calendar days. The contract will be set aside as either 100% for Indian Economic Enterprises or 100% for small businesses.
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Other files
| File | Type | Posted |
|---|---|---|
| A10 Attachment 3 Sources Sought IEE Self-Performance Worksheet.docx | DOCX document | |
| A10 Attachment 2 IHS IEE Representation Form_Jan 2022.pdf |
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Text version
Sources Sought Submittal Questionnaire Company Information
Company Name
Website
Physical Address
SAM UEI Number
Point of Contact
Contact Name
Phone Number
Email Address
Proposal, Yes or No?
If a solicitation is issued, will your firm/company be submitting a proposal? Indicate Yes or No.
Type of Business
Native American-owned (IEE/ISBEE), SBA certified 8(a), SBA Certified HUB Zone, Service Disabled Veteran-Owned Small Businesses (SDVOSB), Women Owned Small Business (WOSB), and/or Small Businesses (SB). For more information refer to http://www.sba.gov. IEE firms must submit Attachment 1: IHS IEE Representation Form (Jan 2022) along with the controlling enterprise’s Tribal enrollment/certificate of Degree of Indian Blood documentation
Type of Business?
Bond Capacity
Single Bonding Capacity
Aggregate Bonding Capacity
Experience Submission
Requirements: Submit at least two (2) but no more than five (5) projects completed by your firm within the last six (6) years that are similar to the work that will be required under this project
PROJECT 1
Project Name and Number
Prime or Subcontractor?
Dates of Construction
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
Project Name and Number
Prime or Subcontractor?
Dates of Construction
Contract Value
Contract Location
Contract Completion Date
Description of Scope Performed and Complexity (expand as needed)
PROJECT 3
Project Name and Number
Prime or Subcontractor?
Dates of Construction
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)
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