A10 Attachment 1 SS Submittal Questionnaire.docx
DOCX document 18 KB Posted
- Attached to
- Town of Red Rock Water Main Replacement
- Solicitation number
- 75H70123R00071
About this file
This document is a submittal questionnaire for a sources sought notice related to the Town of Red Rock Water Main Replacement project solicited by the Department of Health and Human Services Indian Health Service. The questionnaire requests company information including name, website, address, SAM registration, point of contact, and bond capacity. It also requests whether the company will submit a proposal if a solicitation is issued. Companies must indicate their business type such as 8(a), HUBZone, SDVOSB, WOSB, small business or Native American-owned. The questionnaire requires a description of two to five similar past projects as a prime contractor or subcontractor including contract value, location, completion date, scope, and references. Relevant experience must be on federal, state, tribal or other government projects completed within the last six years.
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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
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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