EXHIBIT E - Past Performance Questionnaire 36C24420R0086.docx

DOCX document 539 KB Posted

Attached to
Z1DA--Create Clinical Space Bldg. 18 Federal contract opportunity
Solicitation number
36C24420R0086
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 4

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This past performance questionnaire is for a contractor bidding on the Create Clinical Space Bldg. 18 construction project at the Lebanon VA Medical Center. The contractor must have experience constructing clinical spaces and demonstrate successful past performance ratings in areas such as management, quality, schedule adherence, safety, and regulatory compliance. References will evaluate the contractor's performance on a scale of 0 to 5 and provide explanations for their overall rating. Relevant experience includes constructing clinical spaces for the VA or other healthcare clients. The bid due date is December XX, 2019.

The related federal contract opportunity is a pre-solicitation notice for construction services for the Create Clinical Space Bldg. 18 project with a performance period of 930 calendar days. The VA will issue an RFP on or around August 15, 2020. The estimated value is between $5-10 million. The NAICS code is 236220 and it is set aside 100% for SDVOSBs. Questions are due by email by the specified date. A pre-bid meeting will be held approximately one week after RFP posting. Respondents must be registered in SAM and CVE verified to be considered for award.

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Other files for this federal contract opportunity

Other files attached to Z1DA--Create Clinical Space Bldg. 18, newest first.
File Type Posted
S06 Amend. A0004 to 36C24420R0086 9-21-20.docx DOCX document
S03 SAM Wording for Amend A0004 9-21-20.docx DOCX document
S06 Amend. A0003 to 36C24420R0086 9-17-20.docx DOCX document
S03 SAM Wording for Amend. A0003 9-17-20.docx DOCX document
S04 Sign in Sheet- Site Visit - Create Clinical Space Bldg. 18.pdf PDF
Amend A0002 Drawings 9-17-20.zip ZIP file
S06 Amend A0001 to 36C24420R0086 - Revised 8-13-20.docx DOCX document
Amend. A0002 Specifications 9-17-20.zip ZIP file
S06 Amend. A0002 to 36C24420R0086 9-17-20.docx DOCX document
S03 FBO Wording for Amend A0002 9-17-20.docx DOCX document
EXHIBIT E - Past Performance Questionnaire 36C24420R0086 - Revised 8-13-20.docx DOCX document
S06 Amend A0001 to 36C24420R0086 8-13-20.docx DOCX document
EXHIBIT D - Sample Transmittal Letter for Past Performance Evaluation Questionnaire 36C24420R0086 - Revised 8-13-20.docx DOCX document
EXHIBIT D - Sample Transmittal Letter for Past Performance Evaluation Questionnaire 36C24420R0086.docx DOCX document
S02 Specifications - Vol 1 Clinical Space Bldg. 18.pdf PDF
36C24420R0086_2.docx DOCX document
P03 Sole Source Justification - Edwards EDT(1).pdf PDF
P03 Sole Source Justification - Siemens Security(1).pdf PDF
S02 Wage Determination 7-03-20.pdf PDF
S02 Specifications - Vol 2 Clinilcal Space Bldg. 18.pdf PDF
P03 Sole Source Justification Best Locks(1).pdf PDF
EXHIBIT C - Calculation of Self-Performed Work 36C24420R0086.docx DOCX document
EXHIBIT B - Subcontractor Information and Consent Form 36C24420R0086.docx DOCX document
S02 Drawings - Create Clinical Space Bldg.pdf PDF
P03 Sole Source Justification - Delta Controls(1).pdf PDF
EXHIBIT A - Past Performance Relevancy Questionnaire 36C24420R0086.docx DOCX document
S02 Solicitation 36C24420R0086 - Posted 8-13-20.docx DOCX document
36C24420R0086_1.docx DOCX document
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Department of Veterans Affairs

Network Contracting Office 4 1010 Delafield Road Pittsburgh, PA 15215

Past Performance Questionnaire for: 36C24420R00086 Create Clinical Space Bldg. 18 Construction

INSTRUCTIONS TO OFFEROR

Complete the CONTRACTOR INFORMATION section, below (type answers into light blue shaded boxes). Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions, below.

Company Name

Street Address

Point of Contact (POC)

City

POC Phone Number

State

Reference Project Title

Zip Code

Contract Period of Performance (start to finish):

Email

Contract Number

Contract Dollar Value

Description of Work

Role of Contractor on This Project (check appropriate box)
|_| Prime Contractor |_| Sub-contractor |_| Key Personnel

INSTRUCTIONS TO REFERENCE CONTACT

The contractor named above is submitting a proposal for a United States Department of Veterans Affairs contract, and has sent this form to you as a past performance reference contact. Please complete the following pages in full (all areas shaded in light yellow, below). Once completed, please send the form to the Contracting Officer via postal mail or email directly to:

Department of Veterans Affairs Erie VA Medical Center ATTN: Donald Kalivoda / 36C24420R0086 135 East 38th Street Erie, PA 16504 Email address: donald.kalivoda@va.gov

Please return the completed form ASAP, but no later than 1:00 pm local time, December XX, 2019.

If you have any questions, please contact the Contracting Officer: donald.kalivoda@va.gov.

RESPONDENT INFORMATION [completed by Reference Contact]

Company Name

Street Address

POC Name

City

Phone Number

State

Email

Zip Code

PERFORMANCE INFORMATION: Choose the number on the scale of 0 (Neutral) to 5 (Exceptional) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE AN EXPLANATION FOR THE OVERALL RATING in the Remarks section, below.

0
1
2
3
4
5
NEUTRAL
UNACCEPTABLE
MARGINAL
ACCEPTABLE
VERY GOOD
OUTSTANDING
No record of past performance, or not applicable or the record is inconclusive.
Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.
Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.
Performance met most contractual requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.
Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems, which the contractor resolved in a timely, effective manner.
Performance exceeded all contract requirements. There were no problems.
The Contractor …
0
1
2
3
4
5

QUALITY – MANAGEMENT & WORKMANSHIP

1.
Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.
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2.
Demonstrated ability to hire, maintain, and replace, if necessary, qualified construction personnel during the contract period.
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3.
Provided and followed approved quality control plan and/or inspection procedures to meet contract requirements.
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4.
Corrected deficiencies in timely manner and pursuant to their quality control procedures.
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5.
Submittals clearly identified the proposed item IAW the specifications and drawings.
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6.
Suggested alternative approaches to problems.
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TIMELINESS AND ADHERENCE TO SCHEDULE

0
1
2
3
4
5
7.
Contractor provided timely notices of possible delays/schedule revisions.

REMARKS:

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8.
Timeliness in submitting submittals and reports and responding to agency inquiries, RFP's, etc.
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9.
Developed realistic and met approved progress schedules.
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BUSINESS PRACTICES/CUSTOMER RELATIONSHIP AND ABILITY TO PERFORM

10.
Displayed initiative to solve problems.
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11.
How well did the contractor work independent of Government guidance, oversight and assistance?
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12.
Subcontractors / tradesmen were adequately managed and coordinated. Explain any subcontracting issues (positive or negative) that impacted the performance of your contract(s).
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13.
For contract changes, contractor provided timely and realistic change order proposals.
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COMPLIANCE & SAFETY

0
1
2
3
4
5
14.
Reports (i.e., daily, test, logs) / records were submitted completely and accurately satisfy the requirement.
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15.
Applicable to Federal Contracts –Contractor complied with applicable Federal Laws and Regulations such as Construction Wage Rate Requirements – timely payrolls and compliance; Drug-Free Workplace; Environmental Regulations and Use of Recovered Materials; Executive Order 13101 Greening the Government.
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16.
Contractor’s safety program was in compliance with federal regulations. Contractor implemented and followed their safety plan and ran a “safe jobsite”.
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INFECTION CONTROL

17.
Contractor had an Infection Control Process in place and complied with agency Infection Control Requirements.
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OVERALL CUSTOMER SATISFACTION

18.
Demonstrated reasonableness in modifications cost proposal.
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19.
Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
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YES
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NO
20.
Would you award another contract to this contractor? If not, please explain in “remarks.”
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YES
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NO
OVERALL PERFORMANCE RATING:
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REMARKS (Please use as much space as is needed – the box will expand as you type).

I hereby certify that the information that I have reported above is accurate to the best of my knowledge.

Printed Name

E-mail address

Business Title

Signature

Date

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