36C26318R0047-002.pdf

December 6, 2017 Page 1 of 3

PAST PERFORMANCE QUESTIONNAIRE

Respondent Information

(The AE firm is to send this PPQ to their references identified under Part 1 IF A CPARS IS NOT AVAILABLE FOR THAT CONTRACT. Once completed, FORWARD pages 1 - 3 to the Contracting Officer – kenneth.spohn@va.gov)

Name of A-E Firm being rated:

Choose the number on the scale of 1 to 5 that most accurately describes the contractor’s performance. PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2.

Evaluation Areas: Please circle a number or indicate “not applicable” (N/A).

1. CUSTOMER SATISFACTION:

A Customer would have no reservations in awarding another contract to the Contractor.

1 2 3 4 5 N/A

2. QUALITY:

A Contractor provided effective quality control and/or inspection procedures to meet the contract requirements

1 2 3 4 5 N/A

B Contractor provided well researched and clearly identified submittals that matched contract requirements

1 2 3 4 5 N/A

C Contractor completed all work with good workmanship and in conformance with the specifications

1 2 3 4 5 N/A

D Contractor corrected deficiencies in a timely manner and pursuant to their quality control plan

1 2 3 4 5 N/A

3. TIMELINESS:

A Contractor met established project schedules to complete the project on time 1 2 3 4 5 N/A

B Contractor provided timely cost proposals 1 2 3 4 5 N/A C Contractor submitted the progress schedule and progress reports as required 1 2 3 4 5 N/A

D Contractor provided on time submittals as required 1 2 3 4 5 N/A E Contractor provided payrolls for both their employees and their subcontractors employees as required

1 2 3 4 5 N/A

F Contractor provided timely resolution of all punch list items

1 2 3 4 5 N/A

4. RESPONSIVENESS

A Contractor acted promptly to resolve problems, ensuring compliance with contract requirements and safety regulations

1 2 3 4 5 N/A

Ratings 5 Outstanding 4 Excellent 3 Satisfactory 2 Marginal 1 Unsatisfactory

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B Contractor was reasonable and cooperated to resolve problems, attended meeting as needed, and maintained communication with the government to keep the project on schedule or minimize the delay

1 2 3 4 5 N/A

C Contractor identified problems as they occurred;

suggested approaches to the problems; displayed initiative to solve problems and performed as a Team Member

1 2 3 4 5 N/A

D Contractor responded to warranty issues within the time frames specified in the contract

1 2 3 4 5 N/A

5. SUBCONTRACTS AND MANAGEMENT:

A Contractor provided experienced/qualified managers and supervisors with the technical and administrative abilities needed to meet contract requirements

1 2 3 4 5 N/A

B Contractor hired quality subcontractors and effectively managed and coordinated their work

1 2 3 4 5 N/A

C Contractor hire, maintained and replaced as necessary, qualified personnel and subcontractors/suppliers

1 2 3 4 5 N/A

D Contractor ensured the project manager had sufficient authority to make decisions and take actions during project performance to keep the project on schedule

1 2 3 4 5 N/A

E Contractor ensured site superintendent and quality control representative were consistently present on site when work was performed

1 2 3 4 5 N/A

F Contractor paid employees/subcontractors/ suppliers as required

1 2 3 4 5 N/A

6. CHANGE/COST CONTROL

A Contractor responsive to contract changes and provided accurate, reasonable and supportable cost proposals

1 2 3 4 5 N/A

B Contractor demonstrated the ability to control costs and/or modifications within the magnitude specified

1 2 3 4 5 N/A

C Contractor validated subcontractor cost proposals prior to submission to the Government

1 2 3 4 5 N/A

Narrative Summary:

1. What were the contractor’s greatest strengths in the performance of the contract?

2. What were the contractor’s greatest weaknesses in the performance of the contract?

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3. Please provide any additional comments concerning the contractor’s performance that you feel would help us in our evaluation.

4. Government Contracts Only: Has/was this contract partially or completely terminated for default or convenience or are there any pending terminations?

Yes No

If yes, please provide explanation

5. Government Contracts Only: Was the contractor ever issued a cure or show cause notice under the referenced contract?

Yes No

If yes, please provide explanation

Evaluated By:

(Signature) (Date)

(Typed or Printed Name) (Address)

(Title) (Address Continued)

(Phone Number) (No. of years’ evaluator worked on contract)

(Project Title, Contract #, and Description)

Thank you for your prompt response and assistance. Please respond no later than posted date. Return this completed questionnaire (pages 1 – 3) via email or by mail to:

Mailing Address: Nebraska Western Iowa Health Care System Attn: Kenneth A. Spohn, Contracting Officer

Contracting (90C) 4101 Woolworth Avenue Omaha, NE 68122

Phone 402-995-4505

OR

Email (preferred method): kenneth.spohn@va.gov mailto:kenneth.spohn@va.gov