General_Contractor_Reference_Form.pdf

SOURCE SELECTION INFORMATION – DO NOT DISCLOSE – SEE FAR 2.101 AND 3.104

GSA PBS Southeastern Sunbelt Region Solicitation 47PE0719R0007

Single Award Indefinite-Delivery Indefinite-Quantity Term Construction Contracts for Florida

General Contractor Reference Form

***Please return this questionnaire via email directly to the Contracting Officer at blake.allen@gsa.gov with the subject line “PPQ for Solicitation 47PE0119R0021." The offeror may also submit the questionnaire with the proposal package.***

Offeror Name:

Referenced Project Information:

Project Title:

Solicitation/Contract Number: ____________________________________________________

Location:

Owners Name and Title:

Phone: Email:

Gov’t Contracting Officer if applicable:

Phone: Email:

Project Delivery Method (Design-Build, Design-Bid-Build, Other (specify))

Type of Contract (FFP, FFP-EPA, Cost-Plus, etc. (specify))

Award Amount: Final Amount:

Contract Award Date: Notice to Proceed Date:

Original Completion Date: Actual Completion Date:

General Scope of Work:

Did this project involves repair and alterations in a government facility or a commercial office building? ( ) Yes ( ) No

Was this project performed in an occupied and functioning space? ( ) Yes ( ) No

Solicitation 47PE0719R0007

Multiple Award Indefinite-Delivery Indefinite-Quantity Term Construction Contracts for Florida

General Contractor Reference Form

(continued)

Offeror:

Please select the discipline(s) or trade(s) involved in this project:

( ) Mechanical ( ) Electrical ( ) Plumbing ( ) HVAC ( ) Communications

( ) Painting ( ) Flooring ( ) Renovations ( ) Restoration

1. Does the contractor have an effective quality control program? ( ) Yes ( ) No

2. Was the project performed in a timely manner? ( ) Yes ( ) No

3. Were the tenants/customers generally satisfied with the services performed by the contractor? ( ) Yes ( ) No

4. Has the contractor performed satisfactorily in accordance with the contractual terms and conditions? ( ) Yes ( ) No

Please explain any “no” responses to the questions above: _____________________________

Describe any terminations (partial or complete), the reason (convenience or default) and the surrounding circumstances, if applicable (attach additional sheets if necessary): ____________

Please provide any other comments regarding this contractor’s performance. _______________

Solicitation 47PE0719R0007

Multiple Award Indefinite-Delivery Indefinite-Quantity Term Construction Contracts for Florida

General Contractor Reference Form

(continued)

Offeror: _____________________________________________________________

Thank you for taking the time to provide your evaluation. The U.S. General Services Administration appreciates the time and effort required in preparing a response.

Based on the above information and any other considerations you may have, please provide an overall adjectival rating of “acceptable” or “unacceptable.”

I hereby assign a rating of ___________________ to the contractor based on my knowledge and experience.

Reference Contact Information:

Name:_________________________________________

Title: __________________________________________

Phone Number: __________________________________

Email Address: __________________________________

Signature Date