Attachment 1. Past Performance Questionnaire. Ashtabula County, OH.pdf

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS

The NCO4 Network Contracting Office, Pittsburgh, Pennsylvania has issued a solicitation to provide leased space for a Clinical Based Outpatient Clinic in Ashtabula County, OH.

Past performance information will be used to evaluate proposals received.

Section A is to be completed by the Offeror. Section A of the enclosed questionnaire lists the contractor who has identified your office as a source to evaluate their past performance. Section A also authorizes release of this information to NCO4 Network Contracting Office, Pittsburgh, Pennsylvania.

The Offeror must provide this entire document to each of its assessors. The Offeror shall submit Past Performance Questionnaire by the closing date of the Solicitation.

Section B in its entirely is to be completed by the assessor(s). An individual assessor knowledgeable of the contractor’s quality of supplies and services rendered is requested to verify, complete the questionnaire and return to Offeror. If evaluating more than one contract for the same contractor, use a separate questionnaire for each contract being evaluated.

Thank you in advance for your cooperation and expeditious response to this request.

SECTION A: Contractor Information (to be completed by the contractor for who past performance information is being collected, prior to forwarding to assessors)

Solicitation Number Project/Requirement Agency

1. Offeror: __________________________________________________

Address: __________________________________________________

2. Contractor Point of Contact __________________________________________________

3. Phone Number (with area code): __________________________________________________

4. Assessor Contract Award number: __________________________________________________

5. Description of Services provided under contract: _________________________________________

6. Contract award date: ___________________

7. a. Tenant improvement cost at time of award: ____________

b. Total tenant improvement cost at completion of build-out: ___________

c. If there is a price difference in line 7a and 7b, explain: ____________________________________

8. Period of Performance: ______________________________________________________________

ASSESSOR INFORMATION:

Assessor Name

Title

Phone Number & Email Address

9. Authorization is hereby granted to provide the information request in this questionnaire to NCO4

Network Contracting Office, Pittsburgh, Pennsylvania.

(Signature)

(Name and Title of Authorizing Official) (Date)

SECTION B: Assessors Information (to be completed by assessors).

Past Performance Evaluation Ratings E – Exceptional/Very Low Risk Offer’s past performance record provides essentially no doubt that the offeror will successfully perform the require effort.

S – Satisfactory/Low Risk Offer’s past performance record provides little doubt that the offeror will successfully perform the require effort.

M – Marginal/Moderate Risk Offer’s past performance record, although satisfactory, provides some doubt that the offeror will successfully perform the required effort.

U – Unsatisfactory/High Risk Offer’s past performance record provides substantial doubt that the offeror will successfully perform the required effort.

N – Neutral/Unknown Risk The offeror has no relevant past performance record.

A thorough search was unable to identify any past performance. Will not rate favorably or unfavorably.

The questions on the survey (see below) shall be rated in accordance with the definitions provided in the Rating Scale. Any unsatisfactory or marginal rating shall be supplemented with an explanation in the comment section.

1. QUALITY OF SERVICE E S M U N

a. Quality of building design, construction, workmanship, quality of materials used, interior spaces, and overall appearance.

b. Did the contractor work with VA to reach the design goal?

c. Timeliness / effectiveness of contract problem resolution without extensive customer guidance.

d. Effectiveness of providing quality control throughout buildout without adverse effect on performance.

e. Overall rating of contractor quality of service.

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

a. Compliance with contract delivery/completion schedules including any significant milestones. (If the schedule was not met, please address below.)

b. Rate the contractor's use of available resources to accomplish tasks identified in the contract.

c. Rate your satisfaction with the contractor's ability to respond to questions and/or comments in a timely manner.

d. Rate the contractor’s ability to submit required reports in a timely manner.

e. Was the original occupancy date met? If not, explain in comment section.

3. CUSTOMER SATISFACTION E S M U N

a. To what extent were the end users satisfied with the project?

b. Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes;

responsiveness to administrative reports, businesslike and communication).

c. To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

d. Overall customer satisfaction.

4. MANAGEMENT / PERSONNEL / LABOR E S M U N

a. Effectiveness of management, including management of subcontractors and/ or labor force?

b. Ability to hire, apply, and retain a qualified workforce to this effort.

c. Government Information Property Control

d. Knowledge/expertise demonstrated by contractor key personnel.

e. Government contract requiring a subcontracting plan (complete if contractor was required to submit and adhere to a small business subcontracting plan. Were small business goals met?

f. Ability to simultaneously manage multiple projects with multiple disciplines.

g. Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes.

h. Effectiveness of overall management (including ability to effectively lead, manage and control the project).

5. COST / FINANCIAL MANAGEMENT E S M U N

a. Ability to meet the terms and conditions within the contractually agreed price(s)?

b. Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the

PM.

c. Is the Contractor's accounting system adequate for management and tracking of costs? (If no, please explain in comment section below)

d. Rate the contractor’s ability to control cost and submit invoices. Were invoices complete, accurate and timely

e. If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? (Indicate if show cause or cure notices were issued, or any default action in comment section below.)

___Yes __No

f. Have there been any indications that the contractor has had any financial problems? (If yes, please explain in the comment section below.)

___Yes __No

6. SAFETY / SECURITY E S M U N

a. To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues?

Includes: following the user’s rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

b. Contractor complied with all general and IT security requirements for the project and personnel security requirements.

7. GENERAL E S M U N

a. ability to successfully respond to emergency and/or surge situations including notifying COR, PM or Contracting Officer in timely manner regarding urgent contractual issues.

b. compliance with contractual term/provisions (if there were specific issues, please explain in the comments section below)

c. in summary, provide an overall rating for the work performed by this contractor.

d. Would you hire or work with this firm again? (If no, please explain in the comments section below)

___ Yes ___No

Comment Section (may use additional pages for comments)

Section (if applicable) Comment

ASSESSOR:

Identify your role in the contract award or administration and the period of your involvement.

Role Period of Involvement Contract Specialist/Contracting Officer Technical Project Lead/Project Officer

OTHERS

(Signature) (Date)

(Typed or Printed/Name) (Organization)

(Phone Number)