Attachment J06 - Company Specialized Experience Form Construction.docx

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Fort Duchesne PHS Indian Health Clinic Renovation
Solicitation number
75H70122R00005
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This document contains a company specialized experience form and details of a related federal contract opportunity for construction services. The company specialized experience form requests details of up to five relevant past construction projects completed within the last five years, including project type and location, construction costs, the company's role, dates of work, and performance references. The federal contract opportunity is a solicitation for the renovation of the Fort Duchesne PHS Indian Health Clinic issued on November 10, 2021 by the Department of Health and Human Services Indian Health Service. It is estimated at over $10,000,000 and is set aside for total small businesses. The performance period is 365 calendar days from notice to proceed.

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16-161-SOL-00001

NCYRTC

Attachment J06. Company Specialized Experience – Construction Form Solicitation 75H701-22-R-00005

COMPANY SPECIALIZED EXPERIENCE – CONSTRUCTION FORM

Provide the following information to show examples of projects your company constructed within the last five (5) years indicating experience with projects of similar type and scope. Use one form per project.

Type of Project Represented Your Firm’s Name Name of Project Location of Project Owner General Scope of Construction Project Your Role (Prime, Joint Venture, or Subcontractor, etc.) and Work Your Company Self-Performed :

Construction Cost Extent and Type of Work Subcontracted Out Dates Construction: Began___________________ Completed______________ % Completed _______ Your Performance Evaluation by Owner, if known Were You Terminated or Assessed Liquidated Damages?

(If either is “Yes”, attach an Explanation) Owner’s Point of Contact for Reference (Name and Company) Current Telephone Number of Reference POC

SOURCE SELECTION SENSITIVE For Official Use Only Volume I – Factor 1 – Specialized Experience

FOR OFFICIAL USE ONLY, SOURCE SELECTION INFORMATION (FAR 3.104)

Response to Solicitation 75H701-22-R-00005

File details come from the government source that posted it. Updated .