B01 Attachment J04 Company Specialized Experience Form Construction.pdf

PDF 127 KB Posted

Attached to
Stephenson Taylor Water Line Extension Federal contract opportunity
Solicitation number
75H70126R00038
Issued by
Department of Health and Human Services Indian Health Service

About this file

This document is a Company Specialized Experience – Construction Form (Attachment J04) used for federal contract evaluation under solicitation 75H70126R00038. The form is a template designed to collect evidence of a contractor's relevant construction project experience within the past six years to demonstrate expertise with projects of similar scope and complexity.

The form requires respondents to provide comprehensive project information across sixteen data fields: project type, firm name, project name, location, owner, general scope of work, facility type, building size (gross square feet and stories), the contractor's role (prime, joint venture, or subcontractor) and self-performed work, contract dollar value, extent and type of subcontracted work, construction dates and completion percentage, owner's performance evaluation, termination or liquidated damages history (with required explanation if applicable), owner's reference point of contact with name and company, and reference contact telephone number. One form must be completed per project. This template is intended as an evaluation tool to assess contractor qualifications during the source selection process and is marked as "For Official Use Only, Source Selection Information" under FAR 3.104.

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B05 Amend A00001.pdf PDF
B01 Attachment J05 Past Performance Questionnaire.docx DOCX document
B01 RFP 75H70126R00038.pdf PDF
B01 Attachment J01a Stephenson WLX bid specs_JW stamped Mar26.pdf PDF
B01 Attachment J01 SOW WLX.pdf PDF
B01 Attachment J03 Self Performed Calculation Sheet.docx DOCX document
B01 Attachment J06 IHS IEE Representation Form.pdf PDF
B01 Attachment J01b Stephenson WLX plan set_JW stamped Mar26.pdf PDF
B01 Attachment J02 WD OK20260036.pdf PDF

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Text version

Volume II – Factor 1 – Specialized Experience

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

Response to Solicitation 75H70126R00038

Attachment J04 - Company Specialized Experience – Construction Form Solicitation Number: 75H70126R00038

COMPANY SPECIALIZED EXPERIENCE – CONSTRUCTION FORM

Provide the following information to show examples of relevant projects your company constructed within the last six (6) years indicating experience with relevant projects of similar scope and complexity. Use one form per project.

(a) Type of Project Represented

(b) Your Firm’s Name

(c) Name of Project

(d) Location of Project

(e) Owner

(f) General Scope of Construction Project

(g) Type of Facility (i.e. office building, hospital, etc.)

(h) Size of building, including number of gross square feet and number of stories

(i) Your Role (Prime, Joint Venture, or Subcontractor, etc.) and Work Your Company Self-Performed

(j) Dollar Value of the Contract

(k) Extent and Type of Work Subcontracted Out

(l) Dates Construction: Began___________________ Completed______________ % Completed _______

(m) Your Performance Evaluation by Owner, if known

Attachment J04 - Company Specialized Experience – Construction Form Solicitation Number: 75H70125R00054

Volume II – Factor 1 – Specialized Experience

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

Response to Solicitation 75H70126R00038

(n) Were You Terminated or Assessed Liquidated Damages?

(If either is “Yes”, attach an Explanation)

(o) Owner’s Point of Contact for Reference (Name and Company)

(p) Current Telephone Number of Reference POC

COMPANY SPECIALIZED EXPERIENCE – CONSTRUCTION FORM

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