B01 Attachment J07 - Company Specialized Experience Form Construction.docx

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Pine Ridge USP 797/800 Pharmacy Remodel Construction Project
Solicitation number
75H70122R00044
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This solicitation seeks construction services for a pharmacy remodel project. The Indian Health Service is requesting proposals for the demolition and replacement of the inpatient and outpatient pharmacy spaces at Pine Ridge Hospital in Pine Ridge, South Dakota. The project magnitude is estimated between $1,000,000 and $5,000,000. The period of performance is 365 calendar days from notice to proceed. The solicitation will utilize lowest price technically acceptable source selection procedures and result in a firm fixed price contract. The opportunity is set aside for small businesses with preference given to Indian Economic Enterprises with a size standard of $39.5 million in average annual revenue. The site visit date and all other deadlines are specified in the solicitation document.

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16-161-SOL-00001

NCYRTC

Attachment J07. Company Specialized Experience – Construction Form

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 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

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

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