A10 Attachment 1 SS Submittal Questionnaire.docx
DOCX document 18 KB Posted
- Attached to
- Peach Springs Staff Quarters Federal contract opportunity
- Solicitation number
- 75H70123R00072
About this file
This document is a sources sought submittal questionnaire for a federal construction project. It requests company information from potential offerors, including type of business, bonding capacity, and experience on similar past projects as a prime contractor or subcontractor. Offerors are asked to provide details for up to five relevant projects completed within the last six years, including contract value, location, description of scope, and references.
The related federal contract opportunity is pre-solicitation notice 75H70123R00072 for construction of staff quarters at Peach Springs, Arizona, to be awarded by the Department of Health and Human Services Indian Health Service. Offerors responding to the sources sought submittal questionnaire will be considered for the forthcoming solicitation for this construction project.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 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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