Past Performance Questionnaire.docx
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- Solicitation number
- 36C24226R0021
About this file
The document is a Past Performance Questionnaire for an Architect-Engineer (A/E) contract opportunity at the Canandaigua VA Medical Center. The project involves professional design services for connecting a force main to the county sewer, with a focus on professional design services including site investigation, assessment, and preparation of construction documents. This is a 100% Service-Disabled Veteran Owned Small Business (SDVOSB) set-aside procurement with a contract value between $1,000,000 and $5,000,000, using NAICS code 541330.
Key submission and award details include a qualification submission deadline of 12:00 PM Eastern Time on Friday, December 19, 2025, with an anticipated contract award date on or before January 31, 2026. Potential contractors must be registered in SAM, verified as an SDVOSB in the SBA's Small Business Search, and have an SF 330 form on file. The procurement is being conducted by the Department of Veterans Affairs' Veterans Health Administration, following the Brooks Act, and requires firms to demonstrate their capacity to perform the majority of work with their own employees.
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PAST PERFORMANCE QUESTIONAIRE AND COVER LETTER
Complete one set of letters and forms for at least three projects identified in your firm’s SF 330 Section F, Example Projects Which Best Illustrate Proposed Team’s Qualifications for This Contract. Additional space or blank sheets may be added to answer any question.
Transmittal Letter to Accompany Past Performance Questionnaire
| FROM: | Idalia Algarin, Contracting Officer |
| NC02 Contracting Office | |
| Idalia.algarin@va.gov |
SUBJECT: Past Performance Questionnaire for Contract(s):
[Insert Company Name] is currently responding to Canandaigua, NY VAMC request for SF 330, Architect-Engineer Qualifications for the “Project No. 528A5-22-507 for the Design to Connect force main to County Sewer”. This Request for SF 330’s requires respondents to identify customers and solicit their response regarding [Insert Company Name] performance.
[Insert Company Name] is providing past performance data to Network Contracting Office (NCO) 2 relating to our performance on contract [Insert contract name/number] and have identified [Insert name of reference] as the point of contact for this contract.
The request for SF 330 instructs that respondents provide customers with the attached questionnaire. Please complete the questionnaire and submit it by 12:00 PM EDT on Friday, December 19. 2025 directly to the VISN 2/Network Contracting Office (NCO) Contracting Officer. The requested data may be submitted by mail or email to the government representative identified below. If the Past Performance Questionnaire is emailed, DO NOT send a hard copy via mail.
Idalia Algarin Contracting Officer Email: idalia.algarin@va.gov
The information contained in the completed Past Performance Questionnaire is considered sensitive and cannot be released to [Insert Company Name]. Please direct any questions about the acquisition or the attached questionnaire to the VISN 2 NCO point of contact identified above.
Thank you, [Insert Company Official Name and Title]
A. GENERAL INFORMATION
A-E FIRM TO BE EVALUATED:
| Firm Name: ________________________ | Telephone: __________________________ |
| Address: | __________________________ Email address: ________________________ |
| __________________________ Point of Contact: ______________________ | |
| __________________________ | |
| __________________________ |
Firm Cage Code: ____________________ Firm Tax ID Number: ________________ Firm DUNS Number: ________________
Project Title: _____________________________________
Description of Project: __________________________________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Description of A-E Firms’ Responsibilities:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Contract Number: ______________________ Dollar Amount: ______________________ Contract Period of Performance: _______________________ The A-E Firm performed as the Prime Contractor Sub-Contractor/Consultant/Team Member Percent of work performed by A-E Firm: Other (Please describe) __________________
B. EVALUATOR INFORMATION:
Evaluator’s Company or Agency
| Name: ____________________________ | Evaluator’s Name: _____________________ | |
| Address: __________________________ | Title of Evaluator: _____________________ | |
| __________________________ | Telephone: __________________________ | |
| __________________________ | E-mail: ______________________________ |
C. SEND COMPLETED QUESTIONAIRE (SECTIONS B through D) TO:
Idalia Algarin Contracting Officer Email: idalia.algarin@va.gov
D. PERFORMANCE INFORMATION: Choose the appropriate rating that most accurately describes the A/E’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ALL RATINGS OF Marginal or Unsatisfactory on page 7 under Narrative Summary.
| Exceptional (5) |
| Very Good (4) |
| Satisfactory (3) |
| Marginal (2) |
| Unsatisfactory (1) |
| N/A |
| Performance meets or met contractual requirements and exceeds or exceeded many of your company’s expectations The contractual performance reflects or reflected few minor problems and corrective actions taken by the contractor appear to be highly effective or corrective actions taken were effective. |
| Performance meets or met contractual requirements and exceeds or exceeded some of your company’s expectations. The contractual performance reflects or reflected some minor problems and corrective actions being taken by the contractor appear to be effective or Corrective actions taken were effective. |
| Performance meets or met contractual requirements. The contractual performance reflects or reflected some minor problems. Corrective actions being taken by the contractor appear to be effective or Corrective actions taken were effective. |
| Performance does or did not meet some contractual requirements. The contractual performance reflects or reflected serious problems(s) for which the contractor has not yet identified acceptable corrective actions or did not provide acceptable corrective actions. |
| Performance does or did not meet most contractual requirements and recovery is not likely or did not occur. The contractual performance contains or contained serious problem (s) for which the contractor’s corrective actions appear ineffective or were ineffective. |
| Not applicable or rater has not observed performance in this area. |
A-E FIRM’S NAME: _______________
PROJECT NAME: _______________
Contract Period of Performance: _______________________ Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.
Place an “X” in the appropriate column using the definitions matrix on page 4.
Item
FACTORS TO BE RATED
| Exceptional (5) |
| Very Good (4) |
| Satisfactory (3) |
| Marginal (2) |
| Unsatisfactory (1) |
| N/A |
Design Services:
| 1. |
| Overall skill level and technical competence of A/E’s personnel. |
| 2. |
| A/E’s ability to identify and resolve design issues expeditiously. |
| 3. |
| A/E’s responsiveness to design review questions. |
| 4. |
| A/E’s ability to effectively coordinate, integrate and manage their consultants/subcontractors/team |
| 5. |
| A/E’s effectiveness and responsiveness in interfacing with the Client’s staff |
| 6. |
| Overall accuracy, completeness and coordination of final design documents. (Quality) |
| 7. |
| A/E’s ability to provide detailed, accurate cost estimates. |
| 8. |
| A/E’s ability to meet contract schedule. |
Follow-On Construction Support Services:
| 9. |
| Thoroughness and timely review of construction submittals. |
| 10. |
| Timely resolution of construction design issues. |
| 11. |
| Overall quality, responsiveness and timeliness of A/E follow-on construction support services. |
LEED (If Applicable):
| 12. |
| Overall accuracy, completeness, timeliness and coordination of LEED documentation. |
| 13. |
| A/E’s ability and understanding of the overall LEED process. |
BIM (If Applicable):
| 14. |
| Overall accuracy, completeness, timeliness and coordination of BIM documentation. |
| 15. |
| A/E’s ability and understanding of the overall BIM process. |
Owner’s Representative on Design/Build Projects (If applicable):
| 16. |
| Overall accuracy, completeness, timeliness and coordination of requirements documents and bridging documents. |
| 17. |
| A/E’s ability, thoroughness, timeliness and support as Owner’s Representative throughout the project. |
Overall:
| 18. |
| How would you rate the A/E’s ability to control cost? |
| 19. |
| How would you rate the A/E’s overall management performance on this contract? |
| 20. |
| How would you rate the A/E’s overall technical/quality performance on this contract? |
| 21. |
| Would you use this A/E again? (If “No”, please comment in the Narrative Summary) |
| YES |
| NO |
Number of A/E Design Errors & Omissions on Project: _______________ Increased Project Cost Due to A/E Design Errors & Omissions: _______________ Contractor’s Name: ___________________ Project Name: ______________________ Contract Period of Performance: _______________________
Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.
NARRATIVE SUMMARY (Use this section to explain any rating from the previous page)
| Item |
| COMMENTS |
36C24223R0049 - Project No. 528A5-23-501 for the Design Install Natural Gas
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