36C24418R0274-005.docx

EXHIBIT C

Past and Present Performance Questionnaire When completed, the information contained herein is "Source Selection Sensitive" and is not to be released outside Government Channels.

Return this page with Questionnaire

Part 1 - Completed by Contractor submitting proposal Reference is provided for:

Contract No./Project Title: Contract #:

3 / 4

Award Date: Location: Cost:

Completion Date:

Brief description of work and your role in the referenced contract:

Part 2 - Completed by person providing reference. Reference provided by:

Company/Agency: Business Address: Telephone Number: Email Address: Relationship to Contract:

If information in Part 1 is not accurate, please indicate:

To obtain an electronic version of the form, please contact Donald Kalivoda at donald.kalivoda@va.gov

The Questionnaire should be submitted directly to Donald Kalivoda, Contracting Officer by the following means: Return via email to Donald.kalivoda@va.gov . Any questions please contact Donald Kalivoda at 814-860-2917

Mark cover sheet: (Attention: RFP 36C24418R0274) "Source Selection Sensitive Information"

Part 3 - Rating Descriptions - Use the following descriptions as guidance in providing ratings.

Exceeded that required by the contract.

Met All that required by the contract.

Met Essentially All that required by the contract.

Met Some that required by the contract.

Failed to Meet that required by the contract.

Part 4 - Questionnaire

a. How well did the Offeror utilize quality control process that ensured conformance to scope and quality requirements?

b. Adequacy of Submittals. Were submittals well researched and clearly identified the proposed item?.

c. Did reports / records submitted completely and accurately satisfy requirements?

d. Comments

a. Timeliness in completing the project

b. Did the contractor provide timely notices of delays/schedule revisions?

c. Timeliness in submitting submittals and reports and responding to agency inquiries, RFP's, etc.

d. Comments

a. Did the contractor provide adequate, competent and qualified management, key personnel and technical personnel capable of meeting contract requirements throughout the performance period of the contract and did contractor comply with specifications?

b. How well did the contractor work independent of Government guidance, oversight and assistance?

c. Did contractor maintain a good relationship with agency contracting and technical/project mgt. personnel?

d. How effective was the contractor in meeting Cost/Price performance targets and controlling costs (i.e. changes, etc.)? Did they demonstrate reasonableness in modifications scope and costs?

e. Were Subcontractors / tradesmen adequately managed and coordinated? Explain any subcontracting issues (positive or negative) that impacted the performance of your contract(s).

f. How flexible, cooperative, and reasonable was the contractor in meeting mission requirements, particularly when faced with short-notice mission changes? (12) How flexible, cooperative, and reasonable was the contractor in meeting mission requirements, particularly when faced with short-notice mission changes?

g. How timely and effective were the contractor’s responses to and resolution of Technical problems? Did the Site Manager have sufficient authority to make decisions or take actions during project performance?

( ) yes ( ) no

h. How effective was the offeror’s environmental program, oversight, project management and QC staff?

i. Was the Site Manager consistently present on site when work was performed?

j. Did the contractor demonstrate the ability to execute multiple projects at the same time?

k. Comments

a. How effective was the contractor’s safety program to ensure compliance with federal, state and local regulations? Did the contractor implement and follow their safety plan? Did they run a “safe jobsite”?

b. Comments

a. How well did the contractor comply with applicable Federal Laws and Regulations such as Davis Bacon Act – timely payrolls and compliance; Drug-Free Workplace; Environmental Regulations and Use of Recovered Materials; Executive Order 13101?

b. Comments

a. Did the contractor have an Infection Control Process in place and how well did the contractor comply with agency Infection Control Requirements?

b. Comments

a. How would you rate the Contractor’s overall performance? Given the opportunity, would you select this offeror again? ( ) yes ( ) no

b. What were the contractor’s top documented strengths, if any, in performing the contract requirements?

c. What were the contractor’s top documented weaknesses, if any, in performing the contract requirements?

d. Other Comments - Please provide any additional information you feel is important not covered elsewhere.

Offeror Name:

Respondent Signature: Date Completed: