Attachment C - Past Performance Questionnaire.docx
DOCX document 26 KB Posted
- Solicitation number
- 36C24621R0026
About this file
This document contains a past performance questionnaire and a presolicitation notice for a federal contract opportunity. The past performance questionnaire is a template for references to evaluate a contractor's performance on previous projects. It requests information on quality, timeliness, management effectiveness, safety compliance, and overall performance.
The presolicitation notice is for project number 590-100 to renovate the pharmacy at the Hampton VA Medical Center to meet USP 797/800 standards. The scope of work includes renovating existing pharmacy space and installing a mobile USP trailer for temporary use. The contract will be set aside for SDVOSBs with a size standard of $39.5 million. The solicitation number is 36C24621R0026 and will be issued on December 3, 2020 via sam.gov. The estimated project completion time is 320 calendar days from notice to proceed.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24621R0026 0003.docx | DOCX document | |
| 36C24621R0026 0002.docx | DOCX document | |
| Attachment B - Corp Experience Form.docx | DOCX document | |
| 36C24621R0026 0001.docx | DOCX document | |
| Section 01 33 23 Shop Drawings.docx | DOCX document | |
| SOW Attachment 001 - Site assessment report.pdf | ||
| Section 01 45 00 Quality Control Requirements.docx | DOCX document | |
| Section 01 35 26 Safety Requirements.docx | DOCX document | |
| Section 01 74 19.doc | DOC document | |
| Section 01 32 16 16 Schedules Design Build only.docx | DOCX document | |
| 36C24621R0026_1.docx | DOCX document | |
| Attachment B - SOW Pharmacy USP 797800.docx | DOCX document | |
| Section 01 81 13 SustainConstrReqmts.docx | DOCX document | |
| SOW Attachment 002 - options location mobile pharmacy.pdf | ||
| Section 01 57 19 Temp Environ Controls.docx | DOCX document | |
| Section M_EVALUATION FACTORS FOR AWARD.docx | DOCX document | |
| Section 01 42 19 Reference Standards.docx | DOCX document | |
| Attachment A - Spec 00 11 21 RFP to DB.docx | DOCX document |
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Text version
EXHIBIT A : PAST PERFORMANCE QUESTIONAIRRE REQUEST LETTER
FROM:
[Insert Company Official Name, Title, and Company Name]
SUBJECT: Request for Past/Present Performance Information
[Insert Company Name] is currently responding to VHA Network Contracting Office 6 and Hampton VA Medical Center, regarding a request for proposal for Project 590-100, Renovate Pharmacy USP 797/800 and Install USP Mobile Trailer. This Request for proposal requires respondents to identify customers and solicit their response regarding [Insert Company Name] performance.
[Insert Company Name] is providing past performance data to VHA Network Contracting Office 6 relating to our performance on contract [Insert contract name/number] and have identified [Insert name of reference] as the point of contact for this contract.
The request for proposal instructs that respondents provide customers with the attached questionnaire. Please complete the questionnaire (Sections B and C) and return it by no later than 5:00PM EST, January 4, 2021. Return the completed questionnaire directly to the Government Contracting Officer, Vangie Miller, via email at vangie.miller@va.gov.
*Do not return this form to the Contractor requesting the reference. *
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 drawings and specifications for accuracy, completeness, and compliance with contract requirements. |
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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, please attach pages.)
Thank you for taking the time to complete this questionnaire.
File details come from the government source that posted it. Updated .