10 Past Performance Questionnaire 2022 03 01.pdf

FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE INFORMATION, see FAR 3.104 and 2.101

PBS PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor/Offeror to complete Blocks 1-4)

2. GENERAL WORK INFORMATION

Other _____________ Joint VentureSubcontractor Prime Contractor Work performed as:

3. CONTRACT INFORMATION

Contract / BPA Number:

Delivery / Task Order / Call Number (if applicable):

Other (Please explain) Cost Reimbursement Firm Fixed Price Contract Type:

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Originally Scheduled Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

4. PROJECT DESCRIPTION

1. CONTRACTOR/OFFEROR INFORMATION

Firm Name:

Address:

Phone Number:

Contact Name:

Email Address:

INSTRUCTIONS FOR CLIENTS COMPLETING THIS QUESTIONNAIRE: PBS requires the Client to email the completed Questionnaire directly to the emails listed on the last page. PBS will not accept completed Questionnaires sent from the Offeror, or Questionnaires which are received later than the required date and time for that zone.

Handwritten responses are sufficient. All respondents will be contacted personally to verify their submission. The Government reserves the right to verify any and all information on this form. The Client’s signature is confirmation allowing the General Services Administration to use the information contained herein as source selection information.

PBS Past Performance Questionnaire, tailored for 47PH0818R0004 July 2014

Project involved: □ Federal building □ Commercial building □ City Permits

□ Occupied building □ Non-occupied building □ Parking garage/lot

□ High-rise building □ Courthouse/legal/executive offices □ Historical building

□ Secured building (requiring security clearances or special badging)

□ Other _______________________________

Tasks involved: □ Carpentry □ Electrical □ Plumbing □ Flooring □ Abatement

□ Wall finishes □ Fire Sprinkler □ Fire Alarm □ HVAC □ Demolition

□ Design-Build □ High-end Woodwork or Millwork □ Office space renovation

□ Substantial night and/or weekend work □ Other _______________________

If Offeror was a subcontractor on this project, who was the prime? (Name/Phone #):

THIS PROPOSAL PACKAGE IS FOR: LOUISIANA ZONE

UEI Number:

DUNS Number:

Contact Phone Number:

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PBS Past Performance Questionnaire, tailored for 47PH0818R0004 July 2014 FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE INFORMATION, see FAR 3.104

Use the following adjective ratings and definitions in your evaluation of the Contractor’s performance.

RATING DEFINITION NOTE

(E) Exceptional Performance met contractual requirements and exceeded many to the Government/Owner’s benefit. The contractual performance of the element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

An Exceptional rating is appropriate when the contractor successfully performed multiple significant events that exceeded requirements and were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone merits an Exceptional rating.

There should have been NO significant weaknesses identified.

(VG) Very Good Performance met contractual requirements and exceeded some to the Government’s/Owner’s benefit. The contractual performance of the element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

A Very Good rating is appropriate when the contractor successfully performed a significant event that exceeded requirements and was of benefit to the Government/Owner. There should have been NO significant weaknesses identified.

(S) Satisfactory Performance met all contractual requirements. The contractual performance of the element contained some minor problems for which corrective actions taken by the contractor were satisfactory.

A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract. There should have been NO significant weaknesses identified.

The contractor should not be given a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

(M) Marginal Performance did not meet some contractual requirements. The contractual performance of the element being evaluated reflected a serious problem for which the contractor did not identify corrective actions. The contractor's proposed actions were only marginally effective or were not fully implemented.

A Marginal rating is appropriate when one or two significant events occurred that the contractor had trouble overcoming, with negative effects.

(U) Unsatisfactory Performance did not meet most contractual requirements and recovery was not accomplished in a timely manner. The contractual performance of the element contained serious problem(s) for which the contractor's corrective actions were ineffective.

An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming, with negative effects. A singular problem, however, could be of such serious magnitude that it alone merits an Unsatisfactory rating.

(N) Not Applicable No information or did not apply to your contract Rating will be neither positive nor negative.

Please ensure your ratings meet the definitions above – example: requirements must be exceeded to earn “Exceptional” or “Very Good” rating.

TO BE COMPLETED BY CLIENT

CLIENT INFORMATION

Client Point of Contact Information

Name:

Title:

Phone Number:

Email:

Address:

Describe your role in the project:

I confirm that the contract information provided on the first page is correct and complete. (Correct 1st page if necessary)

Client’s Signature: Date questionnaire was completed:

Instructions: Select the adjective rating that best reflects your evaluation of the contractor’s performance. Please briefly explain any score other than “Satisfactory” in the comments section.

The contractor…

1. QUALITY U M S VG E N U

Provided professional quality work and the finished work compared favorably to the original intent of the project.

Displayed initiative to identify and correct problems or mistakes as they occurred, and demonstrated consideration for client/tenant concerns (cleanliness, noise, schedule coordination, etc).

2. SCHEDULE/TIMELINESS OF PERFORMANCE U M S VG E N

Developed and met realistic progress schedules, managed schedule variances to remain on time, and submitted deliverables on time.

3. MANAGEMENT/ PERSONNEL/LABOR U M S VG E N

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

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel and subcontractors during the contract period, with limited turnover that did not negatively affect quality or schedule.

4. SAFETY/SECURITY U M S VG E N

Maintained an environment of safety, adhered to its approved safety plan, and responded to safety issues. Maintained construction site security.

5. GENERAL U M S VG E N

Was responsive to contract changes, and negotiated fair pricing for modifications.

6. CUSTOMER SATISFACTION U M S VG E N

How would you rate the contractor's overall performance, including timely resolution of warranty defects (if any) after construction was completed?

7. SUMMARY U S

Would you award another contract to this contractor? Yes No

For ratings of “Exceptional”, please explain how the contractor exceeded many of the requirements to your benefit.

For ratings of “Very Good”, please explain how the contractor exceeded some of the requirements to your benefit.

For ratings of “Marginal”, please explain which of the requirements the contractor did not meet, and how their actions were ineffective. _________________________________________________________

For ratings of “Unsatisfactory”, please explain which of the requirements the contractor did not meet, and how their actions were ineffective. _________________________________________________________

COMMENTS SECTION

Please provide additional information below, and attach additional pages if necessary. Please provide an explanation of any rating other than “Satisfactory” (if applicable) and/or additional remarks.

July 2014

SOURCE SELECTION SENSITIVE INFORMATION, see FAR 3.104FOR OFFICIAL USE ONLY

Special Note to Clients:

If you completed a Questionnaire for any previous round of source selection under this solicitation (such as for the Austin, El Paso, San Antonio, North New Mexico, West Texas, West Oklahoma, Dallas to Shreveport, Arkansas, Fort Worth, Louisiana, Tulsa to Fayetteville, Austin, or Houston zones), you can submit that same Questionnaire IF you indicate on the top of page 1 the new zone for which the Questionnaire is being submitted (hand-written is fine) AND if you sign page 3 with the date you submit the Questionnaire for the new zone(s). Thank you for your support!

For the Louisiana Zone, submit Questionnaires to: R7idiq.la@gsa.gov

Must be received by the email address above no later than April 01, 2022, 5:00 PM Central Standard Time.

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