S-10-0164 Attachment 25 Past Performance Reference Questionnaire 5 Apr 10.doc

PAST PERFORMANCE REFERENCE QUESTIONNAIRE

FOR DESIGN OR CONSTRUCTION FIRMS

AG-9702-S-10-0164

A. Name of Evaluated Firm:

B. Information on Company/Person Providing Reference:

Name:_____________________________________________________________________________ Title:______________________________________________________________________________ Company:__________________________________________________________________________ Company Address:___________________________________________________________________ Telephone No:______________________________________________________________________ Title of Project:_____________________________________________________________________ Contract Number:___________________________________________________________________ Award Date:________________________Start Date:_______________________________________ Location of Contract Performance:______________________________________________________ Completion Date or % Complete: Planned:_______________Actual:__________________________ Length of Time Contractor employed:___________________________________________________ Contract Award Amount:_________________________Actual Cost:__________________________ Type of Space/Building:______________________________________________________________

Complexity of Work: High________Moderate___________Routine___________

Type of Contract:___________________________________________________________________ Actual Sq. Ft. in Project_________________

Number of Stories in Building____________

New Construction: Yes_____ No_______

Addition: Yes__________ No_________

Renovation: Yes________ No__________

Environmental Considerations: Yes_______ No________

Cultural Considerations: Yes________ No__________

LEEDS Certified: Yes_______ No________What Level Certification:_________

Remote Site: Yes__________ No___________

Extreme Weather: Yes______ No__________ If Yes, what kind:_____________

C. Questions: (Some questions may not apply to your contract) Meaning of Numbers: 1=Unacceptable, 2=Poor, 3=Acceptable, 4=Good, 5=Excellent

When numbers are given after a question, please circle the one that best applies.

1. What was the actual work performed by the Contractor?___________________________________

2. How well did the prime Contractor coordinate the work of consultants/subcontractors/supplies/labor forces?

Comments:_________________________________________________________________________

3. How responsive was the Contractor in administrative areas (e.g. processing necessary paperwork)? Were the Contractor’s reports and documentation accurate, complete and submitted in a timely manner?

Comments:_________________________________________________________________________

4. Did the Contractor complete the project within the original contract schedule and budget? If not, explain. Was it due to factors within/beyond their control?

Comments:_________________________________________________________________________ Evaluator Initials___________

5. Did the Contractor promote a cooperative relationship with the Owner, Project Manager and Contracting Officer and did they participate as a full partner in the project development team?

Comments:_________________________________________________________________________

6. Were the number of and final price of change orders reasonable for the size and type of the project? What percentage of the change orders was initiated by the contractor? If design/build, were the only changes initiated by the Owner?

Comments:_________________________________________________________________________

7. Did the Contractor submit an excessive number of RFI’s or submit frivolous RFT’s resulting in change order requests? Yes________ No_________

Comments:_________________________________________________________________________

8. Was the Contractor able to implement changes smoothly without creating new problems?

Comments:_________________________________________________________________________ Evaluator Initials________

9. How would you describe the work quality? Please rate the Contractor’s overall performance? Was the Owner satisfied with the product of the Contractor’s efforts?

Comments:_________________________________________________________________________

10. Were the Contractor’s design phase cost estimates accurate? Yes_____ No_____ If not, how much more/less was the final project result?

Comments:_________________________________________________________________________

11. Did the Contractor’s review of design documents eliminate a significant portion of design and construction conflicts and/or problems during the construction phase? Yes________ No__________

12. Did the Contractor readily address ripple effect, such as time extensions, on change order proposals? Yes______ No_______

13. Were there any serious accidents or numerous minor accidents on this job? If so, how much time was lost due to those accidents? What kind of safety program did the Contractor have? Did the Contractor assign anyone to monitor safety full time? Did the Contractor actively work to prevent accidents? If so, how? If emergencies occurred, how did the Contractor respond?

Comments:_________________________________________________________________________ Evaluator Initials______

14. Were there any labor problems? Did the project include the use of Small Business, Small Disadvantaged Business, Woman Owned, Veteran Owned or Service Disabled Veteran Owned, Small Business subcontractors? If so, how accurate was the Contractor’s proposed small business subcontracting goals with the actual performance.

Comments:_________________________________________________________________________

15. Was the Alternative Disputes Resolution (ADR) process used on this project? How would you rate this firm’s ability to resolve disputes?

Comments:_________________________________________________________________________

16. Please rate the Contractor’s performance in complying with contract requirements, quality achieved and overall technical expertise demonstrated.

Comments:_________________________________________________________________________

17. For Designers, Architect/Engineers only, please rate the design ability of the Contractor.

Comments:_________________________________________________________________________ Evaluator Initials:________

18. For Designers, Architect/Engineers only, were any construction problems precipitated by poor design, planning or mistakes made by the Contractor? Yes_______ No_________ Comments:_________________________________________________________________________

19. Given the opportunity, would you use this Contractor again? Yes____No____Maybe______

Comments:_________________________________________________________________________

20. Are you aware of any other projects performed by this Contractor in the past three years? If so, please list. You may also use this space for any other comments you may have.

Evaluator’s Signature:_______________________________________Date:___________________ When completed, please email signed questionnaire to nbelden@fs.fed.us or fax to (707) 562-9149. *Include a cover sheet when submitting via fax.