Attachment 1 - Past Performance Questionnaire.pdf

(WHEN FILLED IN) SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR

3.104 FOR OFFICIAL USE ONLY

ATTACHMENT 1

PAST PERFORMANCE QUESTIONNAIRE

TRANSMITTAL LETTER SAMPLE

<Your Company Letterhead>

Date: ___________________ To: ________

We have listed your firm as a reference for the work we have performed for you as listed below. Our firm has submitted a proposal under a project advertised by Network Contracting Office 15 (NCO 15), located at 3450 S 4th Street Leavenworth KS 66048.

In accordance with Federal Acquisition Regulations (FAR), they will evaluate our firm's past performance, and your candid response to the attached questionnaire will assist the evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible.

Understand that while the responses to this questionnaire may be released to the offeror, FAR 15.306 (e)(4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained. Only one response from each office is required.

Please send your completed questionnaire to the following address. Do not return them to our company.

Department of Veterans Affairs Network Contracting Office 15 (NCO 15) Attn: Gislaine Dorvil via email to: Gislaine.Dorvil@va.gov and Arnold Payne via Arnold.Payne@va.gov 3450 S 4th Street Trafficway Leavenworth KS 66048

If you have questions regarding the attached questionnaire, or require assistance, please contact Gislaine Dorvil, Contract Specialist at (913) 946-1139 or Arnold Payne, Contracting Officer at (913) 946-1124.

Thank you for your assistance.

Please be advised that “E-Mail” is the preferred method of receiving the requested information.

mailto:Gislaine.Dorvil@va.gov mailto:Arnold.Payne@va.gov

<Signature and Title of Principal>

A. GENERAL INFORMATION: (Contractor to be evaluated)

Contractor’s Name: _________________________________

Telephone Number: _________________________________

Address: __________________________________________

Point of Contact: ____________________________________

E-mail: ____________________________________________

Project Title and Brief Description of Work: __________________________________ *

Contract Number Provided by Offeror: _________________ Dollar Amount: ________ *

Contract Period or Dates of Performance Provided by Offeror: __________________ *

Contractor performed as the __ Prime Contractor ___ Sub-Contractor __Key Personnel

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: _______________________ Title: _____________________

Address: _____________________________________________________________

Telephone Number: ______________________

Email Address: _________________________

C. E-MAIL COMPLETED SURVEY FORM TO: Gislaine.Dorvil@va.gov and Arnold.Payne@va.gov

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E (1) G (2) S (3) M (4) U (5) N (6)

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral Performance meets/met contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets/met contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets/met contractual requirements.

The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet/did not meet some contractual requirements.

The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet Identified Corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet/did not meet most contractual requirements and recovery is not likely in a timely manner.

The contractual performance of the element or sub- element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

mailto:Arnold.Payne@va.gov

CONTRACTOR’S NAME: ____________________________

CONTRACT NUMBER: _____________________________

E=1 G=2 S=3 M=4 U=5 N=6

Place an “X” in the appropriate column using the definitions matrix above. The contractor:

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

1 2 3 4 5 6 NA

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

1 2 3 4 5 6 NA

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

1 2 3 4 5 6 NA

4. Home office participated in solving significant local problems.

1 2 3 4 5 6 NA

5. Followed approved quality control plan.

1 2 3 4 5 6 NA

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

1 2 3 4 5 6 NA

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

1 2 3 4 5 6 NA

8. Provided timely resolution of contract discrepancies.

1 2 3 4 5 6 NA

9. Identified risks/problems as they occurred.

1 2 3 4 5 6 NA

10. Suggested alternative approaches to problems.

1 2 3 4 5 6 NA

11. Displayed initiative to solve problems.

1 2 3 4 5 6 NA

12. Developed realistic progress schedules.

1 2 3 4 5 6 NA

13. Met established project schedules.

1 2 3 4 5 6 NA

14. Provided timely resolution of warranty defects.

1 2 3 4 5 6 NA

15. Was responsive to contract changes.

1 2 3 4 5 6 NA

16. Provided adequate project supervision.

1 2 3 4 5 6 NA

17. Obtained consent of surety for increases in bonding as work-in- progress increased.

1 2 3 4 5 6 NA

18. Paid subcontractors/suppliers in a timely manner.

1 2 3 4 5 6 NA

19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

1 2 3 4 5 6 NA

20. With respect to the safety plan, the contractor:

a. Followed the approved safety plan.

1 2 3 4 5 6 NA

b. Had no significant safety problems at the job site.

1 2 3 4 5 6 NA

21. The contractor met contractual requirements for the following work elements:

a. Installation of standing seam metal roof

1 2 3 4 5 6 NA

b. Installation of brick veneer 1 2 3 4 5 6 NA

c. Installation of HVAC equipment and ductwork

1 2 3 4 5 6 NA

d. Installation of Direct Digital Controls

1 2 3 4 5 6 NA

e. Testing, Adjusting, and Balancing of HVAC systems

1 2 3 4 5 6 NA

f. Phased Construction 1 2 3 4 5 6 NA

22. Cooperated with Government personnel after award.

YES NO

23. Was the contractor ever issued a cure or show cause notice under the referenced contract?

If yes, explain outcome in “remarks.”

YES NO

24. Would you award another contract to this contractor? If not, explain in “remarks.”

YES NO

25. Has contractor demonstrated a history of environmental compliance? If not, explain in “remarks.”

YES NO

26. How would you rate the contractor's overall performance?

1 2 3 4 5 6 NA

Remarks: