J04 Company Specialized Experience Construction Form.docx

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Attached to
Santa Fe Indian Health Center (SFIHC) Roof Replacement and Fall Protection
Solicitation number
75H70125-R-00038
Issued by

About this file

The document is a Company Specialized Experience Construction Form template for a federal contract opportunity related to the Santa Fe Indian Health Center (SFIHC) Roof Replacement and Fall Protection project. The form is designed for contractors to provide detailed information about their previous construction projects, including project type, location, owner, scope, facility type, building size, contract role, contract value, construction dates, performance evaluation, and reference contact information.

The associated federal contract opportunity is a 100% Indian Small Business Economic Enterprise (ISBEE) set-aside solicitation under NAICS code 236220, issued by the Indian Health Service (IHS). The project involves replacing the roof and fall protection at the Santa Fe Indian Health Center located at 1700 Cerrillos Road in Santa Fe, New Mexico. The contract will be a Firm Fixed Price (FFP) with a period of performance of 180 calendar days, and the project magnitude is estimated between $1,000,000 and $5,000,000. The solicitation will be procured as a Request for Proposal (RFP) using Lowest Price Technically Acceptable (LPTA) evaluation criteria, with mandatory SAM registration for interested contractors.

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Text version

16-161-SOL-00001

NCYRTC

Attachment J04 - Company Specialized Experience – Construction Form Solicitation Number: 75H701-25-R-00038

COMPANY SPECIALIZED EXPERIENCE – CONSTRUCTION FORM

Provide the following information to show examples of projects your company constructed within the last six (6) 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)

Response to Solicitation 75H701-24-R-00020

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