J-05 Company Specialized Experience Form.pdf

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CROW/NORTHERN CHEYENNE HOSPITAL UNDERGROUND STORAGE TANK REMOVAL
Solicitation number
75H701-21-R-00053
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Volume I – Factor 2 – Specialized Experience

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

Response to Solicitation 75H701-21-R-00053

J-05 Company Specialized Experience Form Solicitation 75H701-21-R-00053

COMPANY SPECIALIZED EXPERIENCE 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.

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

(h) Construction Cost

(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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