B01 Attachment J07 -Company Specialized Experience Form.pdf
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- Solicitation number
- 75H701-21-R-00049
About this file
This document contains a company specialized experience form and details of a federal contract opportunity for construction services. The federal contract opportunity is a solicitation from the Department of Health and Human Services Indian Health Service to provide all labor, tools, equipment, and other necessary incidentals for the expansion and renovation of an existing 5,000 square foot building leased from the Monacan Nation. The purpose of the renovation is to provide basic healthcare services including primary care, behavioral health, outpatient pharmacy, preventive care, and other services to Native Americans in the region. Respondents to the solicitation must demonstrate past experience on similar construction projects of at least 75% completion or completion within the last seven years by completing the attached company specialized experience form, which requests details on project type, location, owner, costs, scope of work, role, subcontracting, dates, performance evaluations and references.
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Attachment J07 - Company Specialized Experience Form Solicitation 75H701-21-R-00049
Volume I – Factor 1 – Specialized Experience
FOR OFFICIAL USE ONLY, SOURCE SELECTION INFORMATION (FAR 3.104)
Response to Solicitation 75H701-21-R-00049
COMPANY SPECIALIZED EXPERIENCE FORM
Provide the following information to show examples of projects your company constructed that are at least 75% complete or completed within the last seven (7) years indicating experience with projects of similar type and scope. 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) Construction Cost
(g) Scope of Construction Project (Describe scope and relevancy to instant requirement)
(h) Your Role (Prime, Joint Venture, or Subcontractor, etc.) and Work Your Company Self-Performed:
(i) Extent and Type of Work Subcontracted Out
(j) Dates Construction: Began___________________ Completed______________ % Completed _______
(k) Your Performance Evaluation by Owner, if known
(l) Were You Terminated or Assessed Liquidated Damages?
(If either is “Yes”, attach an Explanation)
(m) Owner’s Point of Contact for Reference (Name and Company)
(n) Current Telephone Number of Reference POC
COMPANY SPECIALIZED EXPERIENCE FORM
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