36C24618R0176-007.docx

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Attached to
Project 590-14-112, SCI Crawlspace Emergent Structural Repairs Federal contract opportunity
Solicitation number
36C24618R0176
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 6

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36C24618R0176 SOLICITATION ATTACHMENT C - PAST PERFORMANCE QUESTIONNAIRE.docx

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36C24618R0176

FROM:Contracting Officer
Hampton VA Medical Center
NCO 6 Contracting

SUBJECT: Request for Past/Present Performance Information

1. You have been identified as a point of contact for a past and/or present performance evaluation of ______________________________________. This firm is currently being considered for a contract at the VA Medical Center, Hampton, Virginia.

2. Your prompt attention to this survey will be greatly appreciated. Please be sure to e-mail the completed worksheet directly to Daniel Spaulding: daniel.spaulding@va.gov / NLT 08:00PM EST, Friday, January 19, 2017. Questionnaires shall not be sent back to the Contractor. If you have any questions or concerns regarding this request, please contact Daniel Spaulding at 757-315-3964 or by email at the address listed above.

Past Performance Questionnaire

SECTION A.1: Contractor and Project Information (to be completed by the contractor (offeror) prior to sending to references.

A. Contractor’s name and address: _________________________________________

B. Project Owner -POC: _________________________________________

C. Phone:_________________________________________
D. Email Address:_________________________________________

D. Contract Number: _________________________________________ E. Project Title/Desc of Work: _________________________________________

_________________________________________
F. Contract Type:_________________________________________
G. Project Award Date: ______________Scheduled Completion Date: ________________

Current/Final Completion Date: ________________

H. Project Award Amount: ____________ Current/Final Project Amount: ________________

I. Contractor being evaluated performed as the: Prime Contractor Subcontractor Supplier

A.2: EVALUATED BY: (to be completed by Project Owner)

(Signature) (Date)

_____________________________________ Address: _____________________________ (Typed or Printed Name) _____________________________________ (Title)

(Phone/Fax/Email)

A
B
C
D

NA

Substantial Confidence
Satisfactory Confidence
Limited Confidence
No

Confidence

Unknown Confidence

Based on the offeror’s performance record, there is a high expectation that the offeror will successfully perform.
Based on the offeror’s performance record, there is an expectation that the offeror will successfully perform.
Based on the offeror’s performance record, there is low expectation that the offeror will successfully perform.
Based on the offeror’s performance record, there is no expectation that the offeror will successfully perform.

No performance record is identifiable or the offeror’s performance record is so sparse that no rating can be reasonably assigned.

EVALUATION AREAS

I. Quality A B C D NA

1.
Contractor provided effective quality control and inspection procedures that resulted in a quality-finished project.
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2.
Contractor developed and submitted realistic progress schedules.
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3.
Contractor provided well researched and clearly identified submittals that matched contract requirements.
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4.
Contractor completed all work with good workmanship and in conformance with the specifications, resulting in minor, if any, punchlist items.
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5.
Contractor thoroughly reviewed design package proposals for accuracy, completeness, and compliance with contract requirements.
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6.
Contractor designs were all concise, accurate and captured all details of the site visit.
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II. Timely Performance A B C D NA

1.
Contractor met established project schedules to complete the project on time.
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2.
Contractor performed all work without the issuance of a cure notice or show cause letter. (If a notice was issued, please describe the circumstances on a separate sheet of paper and identify if liquidated damages were assessed.)
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3.
Contractor provided timely cost/design proposals.
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4.
Contractor submitted the progress schedule and interim progress reports as required in a timely manner and the schedule was approved prior to actual construction.
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5.
Contractor provided submittals on time as required.
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6.
Contractor provided payrolls for both their firm and their subcontractor’s employees as required and scheduled
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7.
Contractor provided timely resolution of all punchlist items.
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III. Management Effectiveness A B C D NA

1.
Contractor provided experienced qualified managers and supervisors with the technical and administrative abilities needed to meet contract requirements.
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2.
Contractor hired quality subcontractors and effectively managed and coordinated their work.
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3.
Contractor hired, maintained, and replaces as necessary, qualified personnel and subcontractors/suppliers.
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4.
Contractor ensured the site manager had sufficient authority to make decisions and take actions during project performance to keep the project on schedule.
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5.
Contractor provided timely and satisfactory response to warranty issues after project completion.
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6.
Contractor paid employees/subcontractors/suppliers as required.
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7.
Contractor cooperated to resolve problems, attended meetings and maintained communication to assure satisfactory resolution.
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IV. Compliance with Safety Standards A B C D NA

1.
Adequacy of Safety Plan
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2.
Implementation of Safety Plan
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V. Overall Performance A B C D NA

1.
Please rate the contractor’s overall performance
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Additional Information:

(1) Identify the contractor's overall strengths and weaknesses.

(2) Given the choice, would you award to this contractor again?

(3) Are you aware of any other contracted efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.

(4) Is there anyone else we should send this questionnaire to? Please identify by name, organization, and phone number.

(If more comment space is needed, write on back or attach pages.)

Thank you for taking the time to complete this questionnaire. If you have any additional comments or questions, you can contact Daniel Spaulding at 757-315-3964 or daniel.spaulding@va.gov.

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