B01 Attachment J10 Company Specialized Experience Form.pdf

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Attached to
Mid-Atlantic Tribal Health Clinic Renovation and Expansion
Solicitation number
75H701-22-R-00051
Issued by

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This solicitation is for a construction project to renovate and expand an existing tribal health clinic building. The project includes renovating approximately 27,195 square feet as well as an expansion. Services to be provided in the expanded clinic include primary care, dental, behavioral health, pharmacy, optometry, telehealth, and diabetic care. The construction work is to be performed at 2401 Roxbury Road in Charles City, Virginia and has an anticipated magnitude of over $10 million. The period of performance is 365 calendar days from notice to proceed. This opportunity is set aside for small businesses with a preference for Indian Economic Enterprises. The agency is the Department of Health and Human Services Indian Health Service and they intend to award a firm fixed price construction contract.

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Attachment J10 - Company Specialized Experience Form Solicitation 75H701-22-R-00051

Volume I – Factor 1 – Specialized Experience

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

Response to Solicitation 75H701-22-R-00051

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

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