B01 Attachment 05- Experience Form.docx

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Attached to
Zuni Wastewater Treatment Improvements
Solicitation number
75H70120R00029
Issued by

About this file

This document contains an experience form and details of a federal contract opportunity for wastewater treatment improvements. The experience form requests information on previous construction projects including location, scope, costs, roles, references, and performance to demonstrate experience with similar projects. The federal contract opportunity is a solicitation from the Department of Health and Human Services Indian Health Service for the construction of an improved wastewater lagoon treatment facility on the Zuni Pueblo through a two-phase expansion and renovation of the existing six cell, 32.6 acre facility to a five cell, 49 acre system. This acquisition is set aside for Indian Small Business Economic Enterprises.

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Text version

16-161-SOL-00001

NCYRTC

Attachment 05 - Company Specialized Experience Form Solicitation 75H701-20-R-00029

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-00029

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