Revision 1 - EXHIBIT B Performance Relevancy Questionaire.docx

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Multiple Award Task Order Contract - The Corporal Michael J. Crescenz Medical Center
Solicitation number
36C24421R0064
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This document contains a past performance questionnaire template for a multiple award task order contract solicitation from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 4. The solicitation is for construction services related to the Corporal Michael J. Crescenz Medical Center. Offerors are required to submit details on up to three relevant past projects they have worked on as a prime contractor or subcontractor within the last five years, including contract values, completion dates, descriptions of work performed, and references. Subcontractors to be used on any awarded task orders must also be identified.

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REVISON 1 - EXHIBIT B - Past performance Relevancy Questionnaire

PART 1: Prepare no more than three (3) Part 1 forms:

Provide the following information requested in this format for each of the projects/contracts being described. Projects may be on going and cannot have been completed any later than 5 years prior to the solicitation issue date. Provide frank, concise comments regarding YOUR PERFORMANCE on the contracts you identify. Use additional space as required.

A. Offeror (Your) Name (Company/Division):

B. Project/Contract Title:

C. Contract Specifics:

1. Description of Effort as Prime or _Subcontractor

2. Contract Number

3. Original Contract $ Value Current/Final Contract $ Value

4. If amounts in 3 above are different, provide a brief description of the reason:

5. Completion Date:

1. Original Date:

2. Current Schedule: _____________________

3. Estimate/Final Completion Date:

4. Primary cause for Contract Modifications

D. Provide detailed description of the work performed under the contract and describe why you believe the work is very relevant, relevant or semi-relevant to this solicited project. (Use as much space as necessary)

In addition, address the following

1. Describe the specific elements of the work performed by your firm.

2. Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on projects awarded under this MATOC. Should you intend to use these same subcontractors, please list their company names and described their principal areas of work that they will perform.

3. Address any technical areas about this project you consider uniquely relevant to this solicitation.

E. Point of Contact for Owner/Government agency Contracting Officer and or inspector (COR / COTR); include a current phone number and email address for each.

End of Part 1- Questionnaire Requirements – Prepare and send Exhibit C Package to the reference(s) for each of the no more than three Construction Projects, or Specialty Trade if applicable provided in Exhibit B, Part 1. See below for Exhibit B, Part 2.

Page 1 of Page 1 of Page 1 of Page 1 of Part 2, Additional offeror information required.

A. Name subcontractors and/or Teaming Partners to be utilized on this contract. Multiple subcontractors may be named for the same discipline but are limited to a maximum of three (3) subcontractors per discipline.

(Specialty Trades will address their specific trade for any major subcontractor or Teaming partner)

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