B01 Attachment J05 - Company Specialized Experience Construction Form.docx
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- Solicitation number
- 75H701-24-R-00028
About this file
This document is the Company Specialized Experience - Construction Form for Solicitation Number 75H701-24-R-00028, the Woodrow Wilson Keeble Memorial Health Care Center USP Compliance project. It requests the vendor to provide details on similar construction projects completed within the past seven years, including the project type, scope, the vendor's role, value, and performance. The solicitation is issued by the Department of Health and Human Services' Indian Health Service for a construction project that includes demolition, mechanical reroutes, masonry work, carpentry, glazing, specialties, mechanical, electrical, and plumbing work. The vendor must fill out this form to demonstrate their relevant specialized experience for the required construction work.
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Text version
16-161-SOL-00001
NCYRTC
Attachment J05 - Company Specialized Experience – Construction Form Solicitation Number: 75H701-24-R-00028
COMPANY SPECIALIZED EXPERIENCE – CONSTRUCTION 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 Type of Facility (i.e. office building, hospital, etc.)
Size of building, including number of gross square feet and number of stories Your Role (Prime, Joint Venture, or Subcontractor, etc.) and Work Your Company Self-Performed Dollar Value of the Contract 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)
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