Attachment No. 05 Company Specialized Experience Form.docx

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Attached to
Boiler and Chiller Replacement at Lame Deer, MT
Solicitation number
75H701-20-R-00060
Issued by

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This document includes an attachment for a federal contract solicitation and the related solicitation opportunity. The solicitation is seeking proposals for a boiler and chiller replacement project at the Northern Cheyenne Health Center in Lame Deer, Montana. The magnitude of construction is estimated between $500,000 and $1,000,000. This is a 100% small business set-aside solicitation issued by the Indian Health Service with a NAICS code of 238220 and size standard of $16.5 million. Proposals are due by November 12, 2020 at 2:00 PM Mountain Time. Questions regarding the project must be submitted in writing to the contract specialist Rita Langager by October 29, 2020. A non-mandatory site visit will also be held. The selected contractor will replace the boilers and chillers at the health center located at 420 North Cheyenne Avenue in Lame Deer, Montana.

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Other files

File Type Posted
A00001_Boiler-Chiller Site Visit Agenda and Sign-in.docx DOCX document
A00001_Pre-Proposal Inquiries.xlsx XLSX spreadsheet
A00001_Page 108 from NCSU - SOW Boiler-Chiller - FINAL.pdf.docx DOCX document
Amendment 00001 RFP 75H701-20-R-00060.pdf PDF
RFP-75H701-20-R-00060.pdf PDF
Attachment No. 06 Past Performance Questionnaire (PPQ) Form PPQ-0.docx DOCX document
Attachment No. 02 Plans_Drawings.pdf PDF
Attachment No. 04 Self-Performed Calculation Sheet.docx DOCX document
Attachment No. 01 Scope of Work_Specifications.pdf PDF
Attachment No. 03 Wage Determination MT20200057 08282020.pdf PDF

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16-161-SOL-00001

NCYRTC

Attachment No. 05 - Company Specialized Experience Form Solicitation 75H701-20-R-00060

COMPANY SPECIALIZED EXPERIENCE FORM

Provide the following information to show examples of projects your company constructed within the last seven (7) 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 –Experience

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

Response to Solicitation 75H701-20-R-00060

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