J05 - Company Specialized Experience Form Construction.docx

DOCX document 20 KB Posted

Attached to
Whiteriver Boiler Replacement & Steam System Conversion Federal contract opportunity
Solicitation number
75H701-23-R-00033
Issued by
Department of Health and Human Services Indian Health Service

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This document contains a solicitation notice and company specialized experience form for construction services. The Indian Health Service is soliciting proposals to replace two steam boilers and convert supported steam systems at the Whiteriver Indian Hospital in Whiteriver, Arizona under a single firm fixed price contract. The construction magnitude is estimated between $500,000 and $1,000,000. The period of performance is 180 calendar days from notice to proceed. Offerors must register in the System for Award Management database and check the website frequently for any amendments to the solicitation, as no hard copy documents will be provided. Proposers must submit the company specialized experience form to demonstrate relevant past projects of similar size and scope completed within the last seven years.

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16-161-SOL-00001

NCYRTC

Attachment J05 - Company Specialized Experience – Construction Form Solicitation Number: 75H701-23-R-00033

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 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 75H701-23-R-00033

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