B01 Attachment J04 - Company Specialized Experience Construction Form.docx

This is a Company Specialized Experience Construction Form template used to evaluate bidder qualifications for construction projects. Contractors must complete one form per project to demonstrate relevant experience within the last six years on projects of similar type and scope to the current solicitation for the Zuni Comprehensive Community Health Center (ZCCHC) Cooling Tower Repair by Replacement Project.

The form requires detailed documentation of past projects including project type, firm name, project name and location, owner information, general scope of work, facility type, building size in gross square feet and stories, the contractor's role (prime, joint venture, or subcontractor) and self-performed work, contract dollar value, extent of subcontracted work, construction timeline with percentage completion status, owner performance evaluation, any terminations or liquidated damages assessments, and owner reference contact information with current telephone numbers. This information allows the Department of Health and Human Services Indian Health Service to assess whether the bidder possesses the specialized experience and demonstrated capability necessary to successfully execute the cooling tower repair and replacement work at ZCCHC. The form is identified as SOURCE SELECTION SENSITIVE and For Official Use Only material.