A10 SS Submittal Questionnaire.docx
DOCX document 17 KB Posted
- Attached to
- 75H70122R00079 Belcourt Replace Dry Coolers
- Solicitation number
- 75H70122R00079
About this file
This document provides details for a federal contract opportunity to replace dry coolers at a healthcare facility. The Indian Health Service is seeking information from interested contractors through a Sources Sought questionnaire to determine contractor capabilities and qualifications. Responses are due by August 22nd, 2022. The anticipated project value is between $500,000 to $1 million to design and construct new roof-mounted dry coolers. The project is set aside for small businesses under NAICS code 238220 with a size standard of $16.5 million. Interested contractors must provide company and bonding information, as well as descriptions of two similar past projects completed in the last six years as a prime or subcontractor for federal, state, tribal, or other entities.
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| File | Type | Posted |
|---|---|---|
| A10 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
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
Federal, State, Tribal, or Other?
Project Reference(s)/Agency Point of Contact (Title, Name, Phone, Email)
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