PAST AND PRESENT PERFORMANCE QUESTIONNAIRE.docx
DOCX document 38 KB Posted
- Attached to
- Z2DA--FY26: NRM (PROJ: 516-CSI-142) BB - Site Prep for Emergency Department CT Scanner Replacement
- Solicitation number
- 36C24826Q0004
About this file
This document is a Past and Present Performance Questionnaire for a Department of Veterans Affairs contract opportunity (Solicitation Number 36C24826Q0004) related to a CT Scanner Replacement project at the C.W. Bill Young VAMC in Bay Pines, Florida. The project involves constructing an approximately 790 SF addition to Building 100, including removal and replacement of CT scanner equipment in room 1E-210, adding lead-lined walls, and supporting new medical equipment. The project is valued between $500,000 and $1,000,000, with quotes due by 11/17/2025 at 2:00 PM EST. A mandatory site visit was scheduled for 10/07/2025 at 9:00 AM EST, and potential contractors must submit a detailed performance questionnaire to evaluate their past performance across 22 specific performance metrics, including management capabilities, problem-solving skills, schedule adherence, and overall project execution.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24826Q0004 0005.pdf | ||
| WD-FL20260222 01-02-26.pdf | ||
| Guldmann_GH3_BayPines_VA_Submission_Package.pdf | ||
| 36C24826Q0004 0004.pdf | ||
| Base Offer Price Breakdown - 1 page.xlsx | XLSX spreadsheet | |
| 36C24826Q0004 0003.docx | DOCX document | |
| 516-CSI-142 - Bay Pines ED CT_ADD 1.pdf | ||
| 03 30 00-CAST-IN-PLACE CONCRETE.pdf | ||
| 01 45 29-TESTING LABORATORY SERVICES.pdf | ||
| 36C24826Q0004 0002.docx | DOCX document | |
| RFI_516-CSI-142 Pre-Bid.docx | DOCX document | |
| ED CT scanner site walk sign-in sheet 10-07-25.pdf | ||
| 36C24826Q0004 0001.docx | DOCX document | |
| 516-CSI-142_Bay Pines_ED CT_ Specs.pdf | ||
| VHA Infection Control Risk Assessment.pdf | ||
| 36C24826Q0004_1.docx | DOCX document | |
| EMR 1 page.pdf | ||
| WD-FL20250222 05-23-2025.pdf | ||
| 516-CSI-142_Bay Pines_ED CT_ Drawings.pdf |
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Text version
PAST AND PRESENT PERFORMANCE QUESTIONNAIRE
INSTRUCTIONS TO CONTRACTOR
Complete the CONTRACTOR INFORMATION section below in light blue shaded boxes. Send to the point of contact listed requesting they please complete the form and submit it according to the instructions below.
INSTRUCTIONS TO REFERENCE CONTACT
The contractor named below is submitting an offer for a United States Department of Veterans Affairs contract requirement, and has sent this form to you, in your role as a past performance reference contact. Please complete this form in full (all areas shaded in light yellow, below). Once completed, please send the form to the Contracting Officer only by email:
Department of Veterans Affairs NCO 8 Contracting Office TO: David Hernandez Contracting Officer, Email: david.hernandez1@va.gov
REF SOLICITATION NUMBER: 36C24826Q0004
Please return before required due date of 11/03/ 2025 at 2:00 PM EST.
If you are unable to provide this information, please inform the Contractor listed below.
CONTRACTOR INFORMATION [completed by Contractor] Contractor Company Name
Street Address
Contractor Point of Contact Name
City
Point of Contact Phone Number
State
Reference Project Title
Zip Code
Contract POP (start to finish):
Contract Number
Contract Dollar Value
Description of Work
Role of Contractor on This Project (check appropriate box)
· Prime Contractor ☐ Sub-contractor ☐ Key Personnel
RESPONDENT INFORMATION [completed by Reference Contact] Company Name
Street Address
POC Name
City
Phone Number
State
Fax Number
Zip Code
PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2 in the applicable text box OR in the Remarks section, below (text box will expand to whatever extent is necessary).
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| UNSATISFACTORY |
| MARGINAL |
| SATISFACT ORY |
| VERY GOOD |
| EXCEPTIONAL |
| NEUTRAL |
| 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 contractual requirements. There were some minor problems and corrective actions taken by the contractor are 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 met all contract requirements and exceeded many to the government’s benefit. |
Problems, if any, were negligible and were resolved in a timely, highly effective manner.
No record of past performance or the record is inconclusive
| The Contractor … |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| 1. |
| Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements. |
Narrative:
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 2. |
| Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period. |
Narrative:
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 3. |
| Delegated authority to project managers and supervisors commensurate with contract requirements. |
Narrative:
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 4. |
| Home office participated in solving significant local problems. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 5. |
| Followed approved quality control plan. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 6. |
| Provided effective quality control and/or inspection procedures to meet contract requirements. |
Narrative:
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 7. |
| Corrected deficiencies in timely manner and pursuant to their quality control procedures. |
Narrative:
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 8. |
| Provided timely resolution of contract discrepancies Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 9. |
| Identified problems as they occurred. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 10. |
| Suggested alternative approaches to problems. |
Narrative:
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 11. |
| Displayed initiative to solve problems. Narrative |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 12. |
| Developed realistic progress schedules. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 13. |
| Met established project schedules. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 14. |
| Provided timely resolution of warranty defects. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 15. |
| Was responsive to contract changes. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 16. |
| Provided adequate project supervision. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 17. |
| Obtained consent of surety for increases in bonding as work-in-progress increased. |
Narrative:
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 18. |
| Paid subcontractors/suppliers in a timely manner. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 19. |
| Provided accurate and complete line item cost proposals including all aspects of work required for each task. |
Narrative:
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 20. |
| Cooperated with Government personnel after award. Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 21. |
| How would you rate the contractor's overall performance? Narrative: |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 22. |
| Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” |
| ☐ |
| YES |
| ☐ |
| NO |
| 23 |
| Would you award another contract to this contractor? If not, please explain in “remarks.” |
| ☐ |
| YES |
| ☐ |
| NO |
| 24 |
| To the best of your knowledge, is the contractor rated in CPARS? |
| ☐ |
| YES |
| ☐ |
| NO |
REMARKS (Please use as much space as is needed – the box will expand as you type).
Printed Name/ Title Signature
Source Selection Information--See FAR 2.101 and 3.104
File details come from the government source that posted it. Updated .