Past Performance Questionnaires CM.pdf

Past Performance Questionnaire

Note: Completed questionnaires shall be considered confidential information and may not be seenor reviewedbythe contractor/Offeror.Mail or email completed questionnaires directly to:

Attention: David Stadelman, Contract Specialist General Services Administration Denver Federal Center Bldg. 41, P.O. Box 25546 (8PM-P) Denver, CO 80225-0548 david.stadelman@gsa.gov

Offeror Being Evaluated: _________________________________________________

Offeror’s Company: _____________________________________________________

Evaluator:_________________________________________________________________

Company: _____________________________________________________________

Role/position during construction: _________________________________________

Current Telephone No.:_________________________________________________

(Use this cover sheet for each past performance questionnaire submitted)

USE THIS QUESTIONNAIRE FOR THE COMPANY’S PAST PERFORMANCE

CONTRACTOR PERFORMANCE EVALUATION QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

U.S. GENERAL SERVICES ADMINISTRATION

PUBLIC BUILDINGS SERVICE

ROCKY MOUNTAIN REGION

OVERVIEW

The Offeror shown below is submitting qualifications for Construction Management and Inspection services and provided your name as a customer reference. Part of our evaluation process requires information on the Offeror’s past performance. Your participation is important to us and responses are required by June 18, 2010, 10:00 AM (Mountain Time) for inclusion in our evaluation. Your assistance is greatly appreciated.

SECTION 1: Contract Identification To be completed by the Offeror and provided to the customer referenced

Name of Offeror being evaluated: _______________________________________

Project Location:_____________________________________________________

Project Description: ___________________________________________________

Project Award Amount: $_______________________________________________

Project Final Dollar Amount: $___________________________________________

Explanation for difference in award and final dollar amounts (e.g., unforeseen/differing conditions, owner request, value engineering, design deficiencies): _____________

Year Completed: _________ Project Manager: _________________________

SECTION 2: Evaluator Identification

Name of Evaluator: ________________________________________________

Relation to Contract/Project: ___________________________________________

Company Name: ____________________________________________________

Phone Number (Commercial/DSN): ____________________________________

Email Address: ____________________________________________________

SECTION 3: Rating of Offeror To be completed by the customer:

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

Score Performance Level

5 EXCELLENT - The contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s or customer’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

4 VERY GOOD- The contractor’s performance meets or exceeds contractual requirements to the Government’s or customer’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

3 ACCEPTABLE – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appears, or were, satisfactory.

2 MARGINAL – Performance does not meet some contractual requirements. The contractual performance 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.

1 UNACCEPTABLE – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE - Unable to provide a score.

5 4 3 2 1 N Management Professional conduct Cooperation/responsiveness –timely, solicits feedback, suggests alternatives Offeror is easy to work with, friendly, courteous Oversight of project management Quickly/professionally resolves issues/disputes Review/resolution of project issues

SECTION 4: Narrative Summary Please indicate in writing any additional comments you have of the Offeror and suggestions you may have concerning the following categories:

Strengths of performance:

Weaknesses of performance:

Additional Thoughts:

Would you hire this firm again? __________________________________________________________

SECTION 5: Submission

Thank you for taking the time to fill out this questionnaire. As stated above, when filled in this document is source selection sensitive information IAW FAR 3.104. When completed please mail, hand-deliver, or email directly to:

U.S. General Services Administration Public Buildings Services P.O. Box 25546 Denver, Colorado 80225-0546 PHONE: (303) 236-8000, Ext. 5210

ATTN: David Stadelman (8PSM-P) EMAIL: david.stadelman@gsa.gov

Evaluator’s Signature: _________________________________________ Date:_______________

USE THIS QUESTIONNAIRE FOR THE PROJECT INDIVIDUAL’S PAST PERFORMANCE

CONTRACTOR PERFORMANCE EVALUATION QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

U.S. GENERAL SERVICES ADMINISTRATION

PUBLIC BUILDINGS SERVICE

ROCKY MOUNTAIN REGION

OVERVIEW

The Offeror shown below is submitting qualifications for Construction Management and Inspection services and provided your name as a customer reference. Part of our evaluation process requires information on the Offeror’s past performance. Your participation is important to us and responses are required by June 18, 2010, 10:00 AM (Mountain Time) for inclusion in our evaluation. Your assistance is greatly appreciated.

SECTION 1: Contract Identification To be completed by the Offeror and provided to the customer referenced

Name of Offeror being evaluated: _______________________________________

Project Location:_____________________________________________________

Project Description: ___________________________________________________

Project Award Amount: $_______________________________________________

Project Final Dollar Amount: $___________________________________________

Explanation for difference in award and final dollar amounts (e.g., unforeseen/differing conditions, owner request, value engineering, design deficiencies): _____________

Year Completed: _________ Project Manager/Engineer: __________________

SECTION 2: Evaluator Identification

Name of Evaluator: ________________________________________________

Relation to Contract/Project: ___________________________________________

Company Name: ____________________________________________________

Phone Number (Commercial/DSN): ____________________________________

Email Address: ____________________________________________________

USE THIS QUESTIONNAIRE FOR THE INDIVIDUAL’S PAST PERFORMANCE

SECTION 3: Rating of Offeror To be completed by the customer:

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

Score Performance Level

5 EXCELLENT - The contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s or customer’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

4 VERY GOOD- The contractor’s performance meets or exceeds contractual requirements to the Government’s or customer’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

3 ACCEPTABLE – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appears, or were, satisfactory.

2 MARGINAL – Performance does not meet some contractual requirements. The contractual performance 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.

1 UNACCEPTABLE – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE - Unable to provide a score.

5 4 3 2 1 N Management Professional conduct Cooperation/responsiveness –timely, solicits feedback, suggests alternatives Offeror is easy to work with, friendly, courteous Oversight of project management Quickly/professionally resolves issues/disputes

5 4 3 2 1 N Performance Submittals provided on time/schedule Adequacy / Accuracy of submittals Timeliness of response to comments Quickly identifies issues for resolution

USE THIS QUESTIONNAIRE FOR THE INDIVIDUAL’S PAST PERFORMANCE

5 4 3 2 1 N Closeout Submission of required documentation Timeliness of submissions Format of closeout documentation

SECTION 4: Narrative Summary Please indicate in writing any additional comments you have of the Offeror and suggestions you may have concerning the following categories:

Strengths of performance:

Weaknesses of performance:

Additional Thoughts:

Would you work with this individual again? _________________________________________________

SECTION 5: Submission Thank you for taking the time to fill out this questionnaire. As stated above, when filled in this document is source selection sensitive information IAW FAR 3.104. When completed please mail, hand-deliver, or email directly to:

U.S. General Services Administration Public Buildings Services P.O. Box 25546 Denver, Colorado 80225-0546 PHONE: (303) 236-8000, Ext. 5210

ATTN: David Stadelman (8PSM-P) EMAIL: david.stadelman@gsa.gov

Evaluator’s Signature: __________________________________ Date: _______________