47PD0221R0072 CMS Back on Campus PPQ.pdf

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION SEE FAR 3.104

pages

APPENDIX E.1 Page 1 of 4

PAST PERFORMANCE QUESTIONNAIRE – PRIME CONTRACTOR

Centers for Medicare and Medicare Services, Back on Campus, Phase 2 Renovation Project

The General Services Administration is evaluating past performance in selecting a contractor for the construction of Centers for Medicare and Medicare Services, Back on Campus, Phase 2

Renovation Project. You have been identified by the one of the offerors as someone who could attest to the quality that offeror’s performance on the project listed below. Your completion of the attached questionnaire would be of great benefit in selecting the most qualified firm to perform this project.

Completed questionnaires will be considered procurement sensitive information and will not be seen or reviewed by the offeror in question or any other party not having a need to know. Electronic copies of the completed questionnaire will be emailed to Ray Porter at raymond.porter@gsa.gov and/or Janet

Coker at janet.coker@gsa.gov.

We request receipt of your completed questionnaire by .

OFFEROR BEING EVALUATED:

PROJECT BEING EVALUATED:

NAME OF EVALUATOR:

EVALUATOR’S AGENCY/COMPANY:

EVALUATOR’S ROLE IN PROJECT:

EVALUATOR’S EMAIL ADDRESS:

EVALUATOR’S TELEPHONE NUMBER:

APPENDIX E.1 Page 2 of 4

PAST PERFORMANCE QUESTIONNAIRE – PRIME CONTRACTOR

Centers for Medicare and Medicare Services, Back on

Campus, Phase 2 Renovation Project SECTION 1 –

NUMERICAL RATINGS

Please indicate your level of satisfaction with the contractor’s performance on the project in question by placing an “X” in the appropriate block using the rating scale provided to the right of each question.

This scale is defined as follows:

RATING PERFORMANCE LEVEL

5 EXCELLENT – The contractor’s performance met all contractual requirements and exceeded many to the Government’s or customer’s benefit. The few corrective actions that may have been necessary were provided expeditiously and were highly effective.

4 GOOD - The contractor’s performance met contractual requirements and exceeded

Some to the Government’s benefit. Performance was provided with some minor problems, but corrective action was prompt and effective.

3 ACCEPTABLE – The contractor’s performance met contractual requirements. There were minor problems but the corrective actions taken were generally satisfactory.

2 MARGINAL – The contractor’s performance did not meet some contractual requirements. There were significant problems with the contractor’s performance and the corrective action provided was only marginally effective or was not fully implemented.

1 UNACCEPTABLE – The contractor’s performance did not meet most contractual requirements and corrective action was untimely, ineffective or both.

N NOT APPLICABLE – Unable to provide a rating

MANAGEMENT 5 4 3 2 1 N

Exhibits professional conduct

Cooperation/responsiveness is timely, provides/solicits feedback, suggests alternatives

Offeror is easy to work with, friendly, courteous

Provides effective oversight of project managers/superintendents

Quickly and professionally resolves issues/disputes

Reviews and addresses subcontractor issues

Provides a clear and effective line of supervision on the worksite

Follows and maintains the established project budget

Follows the negotiated subcontracting plan

CONSTRUCTION 5 4 3 2 1 N

Complies with laws and regulations

Coordinates and controls subcontractors, adheres to work schedule

Maintains good construction pace and work environment

APPENDIX E.1 Page 3 of 4

CLOSE-OUT/WARRANTY 5 4 3 2 1 N

Requirement documents are fully submitted

Documents are submitted in a timely manger

As-built drawings – redline drawings are accurately maintained on site per specs

Close-out documents follow the required format

Responses to warranty issues are timely and effective

Noted deficiencies are adequately corrected

SECTION 2 – NARRATIVE COMMENTS

Please provide in the spaces below any additional comments you have regarding the offeror’s performance on the project in question:

1. Strengths of Performance:

2. Weaknesses of Performance:

OVERALL PERFORMANCE 5 4 3 2 1 N

Site management – materials are properly stored and staged, job-site is clean

Adheres to an adequate initial project schedule, schedule revisions are timely submitted

Resolves delays in a timely manner

Completes punch list items in a timely manner

Uses specified materials

Identifies and corrects deficient work timely and effectively

Implements and follows a satisfactory safety plan

Provides high quality workmanship

QC testing is adequate and fully implemented

Overall performance – Likelihood of contracting with this firm on future projects

APPENDIX E.1 Page 4 of 4

3. Describe the contractor’s level of attention to safety and describe any incidents that occurred on the project:

4. Additional Comments: