PAST AND PRESENT PERFORMANCE QUESTIONNAIRE.docx
DOCX document 36 KB Posted
- Solicitation number
- 36C24826Q0128
About this file
This document is a Past and Present Performance Questionnaire for a Department of Veterans Affairs contract opportunity. The solicitation (36C24826Q0128) is for a Design-Build (DB) project to construct a 1.5T MRI Imaging Center (ICC) at the James A. Haley Veterans Hospital in Tampa, Florida. The procurement is a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB) with a Firm Fixed Price contract type, using NAICS code 236220 and a small business size standard of $45M. The project requires furnishing professional services, equipment, labor, materials, and specialty services to investigate the site, design, and construct a new MRI facility that will accommodate Siemens 1.5T High Tech Medical Equipment.
The solicitation is currently in pre-solicitation phase, with a Request for Quote (RFQ) expected to be posted on January 10, 2026, and Phase I quotes due on January 06, 2026, at 10:00 AM EST. The project involves comprehensive design and construction services, including preparation of drawings, phase planning, specifications, and installation of medical imaging equipment. The contracting officer is David Hernandez from the Department of Veterans Affairs Network Contracting Office (NCO) 8, and the performance questionnaire is part of the contractor evaluation process, requiring detailed feedback on various performance metrics from previous project references.
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Other files
| File | Type | Posted |
|---|---|---|
| second floor drawing - ACM.pdf | ||
| first floor drawing.pdf | ||
| 673-CSI-132 SOW RFI update.docx | DOCX document | |
| 673-CSI-132 RFI Responses.docx | DOCX document | |
| 36C24826Q0128 0003.pdf | ||
| WD-FL20260208 01-02-26.pdf | ||
| 673-CSI-132 - Hazardous Materials Report 60 PERCENTAGE.pdf | ||
| 36C24826Q0128 0002.pdf | ||
| sign in sheet.pdf | ||
| VA James A Haley1 5T MRI -90 CD Progress Specifications 12-15.pdf | ||
| VA James A Haley 1 5T MRI -90 CD-Progress Drawings 12-15.pdf | ||
| 36C24826Q0128 0001.pdf | ||
| 2510179R0-DRAWINGS.pdf | ||
| WD FL20250208 05232025.pdf | ||
| Experience information Sheet.pdf | ||
| Base Offer Price Breakdown - 1 page.xlsx | XLSX spreadsheet | |
| EMR 1 page.pdf | ||
| 36C24826Q0128_1.pdf | ||
| 2510179R0-DRAWINGS.pdf | ||
| 673-CSI-132 SOW.docx | DOCX document | |
| 36C24826Q0128.docx | DOCX document |
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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: 36C24826Q0128
Please return before required due date of 01/06/2026 at 10:00 AM 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: |
| ☐ |
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| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 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: |
| ☐ |
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| ☐ |
| ☐ |
| ☐ |
| ☐ |
| 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 .