36C24619R0078-002.pdf

ATTACHMENT 1 - PAST PERFORMANCE QUESTIONNAIRE

Please send this questionnaire to at least three (3) projects identified in your firm’s SF 330 Exhibit A, Example Projects which best illustrate proposed team’s qualifications for this work.

Additional space or blank sheets may be added to answer any question. IF PAST PERFORMANCE

ACASS/CPARS IS NOT AVAILABLE, THEN OFFEROR TO SEND THIS QUESTIONNAIRE TO MINIMUM

OF 3 PRIOR CLIENTS AS LISTED IN SF330. OFFEROR TO PLACE THEIR NAME IN RESPECTIVE

BLANK SPACES BELOW, AS INDICATED “AE NAME” “AE FIRM TO BE EVALUATED.” NOTE: AE is abbreviation for Architect-Engineer

Transmittal Letter to Accompany Past Performance Questionnaire

A. GENERAL INFORMATION

FROM: _________________________________

SUBJECT: Past Performance Questionnaire for Contract(s):

AE Name____________________________________ is currently responding to Salem Veteran Affairs Medical Center, Salem, Virginia request for SF 330, Architect-Engineer Qualifications for the “Upgrade Fire Alarm System”, Project # 658-19-105, at Veterans Affairs Medical Center, Salem, VA. This Request for SF 330’s requires respondents to identify customers and solicit their response regarding ____________________AE Name________________ performance.

Recommender Name___________________________________ is providing past performance data to Salem VA Medical Center relating to our performance on contracts and have identified Recommender Contact______________________________________ as the points of contact for these contracts.

The request for SF 330 instructs that respondents provide customers with the attached questionnaire. Please complete the questionnaire and submit it by email, regular mail or delivery service by (June 7, 2019 11:59 PM ET), directly to the VA Contracting Officer, Bryant Guerrant, at:

Bryant Guerrant Contracting Specialist Department of Veterans Affairs 1970 Roanoke Blvd., Bldg. 74, Room 211 Salem, Virginia 24153 Bryant.guerrant@va.gov

The information contained in the completed Past Performance Questionnaire is considered sensitive and cannot be released to AE Name____________________. Please direct any questions about the acquisition or the attached questionnaire to Bryant Guerrant, Contracting Specialist, at point of contact identified above.

A. GENERAL INFORMATION (CONTD’)

A-E FIRM TO BE EVALUATED:

Firm Name: _________________________ Telephone: _________________________

Address: _________________________ Email: ____________________________

Point of Contact: _____________________

Firm Cage Code: _____

Firm Tax ID Number: ________

Firm DUNS Number: ________

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)

EVALUATOR INFORMATION:

Evaluator’s Company or Agency

Name: ________________________ Evaluator’s Name: ________________

Address: ________________________ Title of Evaluator: ________________

________________________ Telephone: ____________________

E-mail: ______________________

B. 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 Exceptional and Marginal-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.

C. Using the Performance Information Descriptions in ‘B’ above, place an “X” in the appropriate columns using the definitions matrix in ‘B’ above.

Ite m

FACTORS TO BE RATED

E xc ep tio na l (

5)

V er y G oo d

(4

S at is fa ct or y (3

M ar gi na

2)

U ns at is fa ct or y

(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. Coordination and control of subcontractors

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.

9. Cooperation and responsiveness

10. Management of Resources/Personnel

11. A/E’s effectiveness and responsiveness in interfacing with the Client’s staff

12. Compliance with regulations xc ep tio na y G oo d

(4

S at is fa ct or y (3

M ar gi na at is fa ct or y

(1

13. Professional conduct

14. Changes activity/Change order(s) requested

15. Adequacy of work force

16. Met/corrected deficiencies, if any

17. Good faith effort made along complete project

Follow-On Construction Support Services:

18. Thoroughness and timely review of construction submittals.

19. Timely resolution of construction design issues.

20. Overall quality, responsiveness and timeliness of A/E follow-on construction support services.

LEED (If Applicable):

21. Overall accuracy, completeness, timeliness and coordination of LEED documentation.

22. A/E’s ability and understanding of the overall LEED process.

BIM (If Applicable):

23. Overall accuracy, completeness, timeliness and coordination of BIM documentation.

24. A/E’s ability and understanding of the overall BIM process.

Owner’s Representative on Design/Build Projects (If Applicable):

xc ep tio na y G oo d

(4

S at is fa ct or y (3

M ar gi na at is fa ct or y

(1

25. Overall accuracy, completeness, timeliness and coordination of requirements documents and bridging documents.

26. A/E’s ability, thoroughness, timeliness and support as Owner’s Representative throughout the project.

Overall:

27. How would you rate the A/E’s ability to control cost?

28. How would you rate the A/E’s overall management performance on this contract?

29. How would you rate the A/E’s overall technical/quality performance on this contract?

30. 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: _______________

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.

D. NARRATIVE SUMMARY (Use this section to explain any rating from the previous pages, especially 5 Exceptional and 1 Unsatisfactory and N/A-Not Applicable)

Item COMMENTS

Item COMMENTS

Add more rows as needed

SEND COMPLETED QUESTIONAIRE TO:

Bryant Guerrant, Contracting Specialist Department of Veterans Affairs 1970 Roanoke Blvd., Bldg. 74, Room 211 Salem, Virginia24153 BY EMAIL: bryant.guerrant@va.gov

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