Attachment 15 - Past Performance Questionnaire.docx
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- Solicitation number
- 36C77622R0027
About this file
This pre-solicitation notice seeks SF 330 qualification packages from architecture and engineering firms for design services related to EHRM infrastructure upgrades at the VA Medical Center in Salisbury, North Carolina. Firms must have experience designing network infrastructure installations, renovations, and upgrades involving fiber optics, structured cabling, electrical and mechanical systems, security, and project management. The project value is between $20-50 million.
The solicitation is a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses. Responses are due February 21, 2022 and will be evaluated on specialized experience, personnel qualifications, capacity, past performance, and knowledge of the project locality. The highest rated firm will be invited to discussions and site visits, with award going to the negotiator of fair and reasonable rates. The design must be complete within 365 days of award.
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Text version
ATTACHMENT 13- PAST PERFORMANCE QUESTIONNAIRE
1. Contractor Information
Firm Name:
Address:
Phone Number:
Point of Contact:
Contact Phone Number:
DUNs Number:
2. Work Performed as: |_| Prime Contractor |_| Sub Contractor |_| Joint Venture |_| Other
Percent of project work performed:
If subcontractor, who was the prime (Name/Phone #):
3. Contract Information Contract Number:
Delivery/Task Order Number (if applicable):
Contract Type: |_| Firm Fixed Price |_| Cost Reimbursement |_| Other (Please specify):
Contract Title:
Contract Location:
Project Description:
Complexity of Work |_| High |_| Med |_| Routine Award Date (mm/dd/yy):
Contract Completion Date (mm/dd/yy):
Actual Completion Date (mm/dd/yy):
Explain Differences:
Original Contract Price (Award Amount):
Final Contract Price (to include all modifications, if applicable):
Explain Differences:
Rating: Please evaluate the past performance using only the following ratings without variation. DO NOT RATE ON A “+” OR “-“ SCALE. If a “+” or “-“ is used, the rating without the "+" or "-" will be applied. In addition to the ratings, please provide a short narrative in the appropriate block or in the remarks section of this form.
| “O” |
| Outstanding |
| The Offeror’s performance met contractual requirements and exceeded many requirements to the Client’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the offeror were highly effective. |
| “A” |
| Above Average |
| The Offeror’s performance met contractual requirements and exceeded some requirements to the Client’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the offeror were effective. |
| “S” |
| Satisfactory |
| The Offeror’s performance met contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the offeror were satisfactory. |
| “M” |
| Marginal |
| Performance did not meet some contractual requirements. Performance indicated that there are some potential risks associated with the quality products, timeliness of service, and contract performance. |
| “U” |
| Unacceptable |
| Performance did not meet contractual requirements. The contractual performance reflected a serious problem for which the offeror has yet to identify corrective actions or the offeror’s proposed actions appear only marginally effective or were not fully implemented. |
Please rate and provide any supporting information/comments for the following:
| 1. The quality of the working relationship with the client (the tenant and/ or owner). |
| O A S M U |
| 2. The professionalism and integrity with which offeror conducted business. |
| O A S M U |
3. The responsiveness to the client’s needs and expectations.
O A S M U
| 4. The Offeror’s ability to successfully management and perform the project. |
| O A S M U |
| 5. The offeror’s level of communication. |
| O A S M U |
| 6. The quality control of the project. |
| O A S M U |
7. Any Value added to the project as the result of cost savings, favorable financing, positive asset management, etc.
Yes No
| 8. Would you award another contact to the party being evaluated? If no, please explain. |
| Yes No |
| 9. The delivery of the project within the budget and on schedule. |
| O A S M U |
10. Other relevant aspects in the management of a project development for the client.
| 11. Overall rating for this firm: |
| O A S M U |
Signature of Evaluator
Date
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