ATTACHMENT 4 - Past Performance Forms.pdf

(WHEN FILLED IN)

SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104

FOR OFFICIAL USE ONLY

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: (Contractor to be evaluated)

Contractor’s Name:

Telephone Number: Fax Number:

Address: Point of Contact:

E-mail:

Project Title and Brief Description of Work: ______________________________________ *

Contract Number Provided by Offeror: _____________________ Dollar Amount: _______ *

Contract Period or Dates of Performance Provided by Offeror: *

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

(WHEN FILLED IN)

SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104

FOR OFFICIAL USE ONLY

SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104

FOR OFFICIAL USE ONLY

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number:

Email Address:

C. E-MAIL COMPLETED SURVEY FORM TO: apolinar.vargas@va.gov

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets/met contractual requirements with many exceeded to the

Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets/met contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets/met contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet/did not meet some contractual requirements.

The contractual performance of the element or sub-element being assessed 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.

Performance does not meet/did not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

(WHEN FILLED IN)

FOR OFFICIAL USE ONLY

CONTRACTOR’S NAME: CONTRACT NUMBER:

Place an “X” in the appropriate column using the definitions matrix above.

The contractor:

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

1 2 3 4 5 6 NA

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

1 2 3 4 5 6 NA

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

1 2 3 4 5 6 NA

4. Home office participated in solving significant local problems. 1 2 3 4 5 6 NA

5. Followed approved quality control plan. 1 2 3 4 5 6 NA

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

1 2 3 4 5 6 NA

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

1 2 3 4 5 6 NA

8. Provided timely resolution of contract discrepancies. 1 2 3 4 5 6 NA

9. Identified risks/problems as they occurred. 1 2 3 4 5 6 NA

10. Suggested alternative approaches to problems. 1 2 3 4 5 6 NA

11. Displayed initiative to solve problems. 1 2 3 4 5 6 NA

12. Developed realistic progress schedules. 1 2 3 4 5 6 NA

13. Met established project schedules. 1 2 3 4 5 6 NA

14. Provided timely resolution of warranty defects. 1 2 3 4 5 6 NA

15. Was responsive to contract changes. 1 2 3 4 5 6 NA

16. Provided adequate project supervision. 1 2 3 4 5 6 NA

17. Obtained consent of surety for increases in bonding as work-in-progress increased.

1 2 3 4 5 6 NA

18. Paid subcontractors/suppliers in a timely manner. 1 2 3 4 5 6 NA

19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

1 2 3 4 5 6 NA

20. With respect to the safety plan, the contractor:

a. Followed the approved safety plan. 1 2 3 4 5 6 NA

(WHEN FILLED IN)

SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 4.104

FOR OFFICIAL USE ONLY

b. Had no significant safety problems at the job site. 1 2 3 4 5 6 NA

21. The contractor met contractual requirements for the following work elements:

a. Installation of standing seam metal roof 1 2 3 4 5 6 NA

b. Installation of brick veneer 1 2 3 4 5 6 NA

c. Installation of HVAC equipment and ductwork 1 2 3 4 5 6 NA

d. Installation of Trane Direct Digital Controls 1 2 3 4 5 6 NA

e. Testing, Adjusting, and Balancing of HVAC systems 1 2 3 4 5 6 NA

f. Phased Construction 1 2 3 4 5 6 NA

22. Cooperated with Government personnel after award. YES NO

23. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

YES NO

24. Would you award another contract to this contractor? If not, explain in “remarks.”

YES NO

25. Has contractor demonstrated a history of environmental compliance? If not, explain in “remarks.”

YES NO

26. How would you rate the contractor's overall performance? 1 2 3 4 5 6 NA

Remarks: