Attachment 8 (Exhibit B) Past and Present Performance Questionnaire.docx

DOCX document 33 KB Posted

Attached to
Y1AA--NRM Tier 2 (PROJ: 573-18-605) BB - Correct Patient Privacy Deficiencies
Solicitation number
36C24821R0139
Issued by

About this file

This document includes a past and present performance questionnaire for contractors bidding on a solicitation from the Department of Veterans Affairs to renovate clinical research laboratories at the Malcom Randall VA Medical Center in Gainesville, Florida. The solicitation number is 573-18-618 BB and responses are due by August 27, 2021. The contractor must provide its company information and have past performance references complete the questionnaire regarding the contractor's performance on previous similar projects within the last five years in areas such as management, quality control, scheduling, and responsiveness. References should rate the contractor's performance on a scale of 1 to 6 and provide explanations for any ratings of 1 or 2.

A related federal contract opportunity posted is for solicitation number 36C24821R0139 to expand and renovate the Cardiothoracic Intensive Care Unit at the same Malcom Randall VA Medical Center to improve patient privacy, access, and functionality. The project value is between $1-5 million and the contract will be a firm fixed price awarded within 120 days. The North American Industry Classification System code is 236220 and the size standard is $39.5 million. The solicitation will be posted on beta.SAM.gov on or around July 28, 2021.

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Text version

573-18-618 BB - Renovate Clinical Research Laboratories, at the Malcom Randall VAMC Network Contracting Office (NCO) 8 Solicitation No. 36C24821R0129

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS TO CONTRACTOR

Complete the CONTRACTOR INFORMATION section, below (type answers into light blue shaded boxes). Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions, below. It is preferred that these are the same clients/projects that you provided with Exhibit A for ease of evaluation and comparison. Projects should be relevant (within the same magnitude of construction) and recent (within 5 years).

INSTRUCTIONS TO REFERENCE CONTACT

The contractor named below is submitting an offer for a United States Department of Veterans Affairs contract requirement, and has sent this form to you, in your role as a past performance reference contact. Please complete this form in full (all areas shaded in light yellow, below). Once completed, please send the form to the Contract Specialist via email directly to:

Department of Veterans Affairs NCO 8 Contracting Office TO: Amber Milton, Contracting Officer REF SOLICITATION NUMBER :

Email Address: amber.milton@va.gov

Please return the completed form no later than August 27, 2021. If you have any questions, please contact Amber Milton via email. Thank you for your assistance in this matter.

GENERAL INFORMATION [completed by Contractor]

Contractor Company Name

Street Address

Contractor Point of Contact Name

City

Point of Contact Phone Number

State

Reference Project Title

Zip Code

Contract POP (start to finish):

Email

Contract Number

Contract Dollar Value

Description of Work

Role of Contractor on This Project (check appropriate box)
☐ Prime Contractor ☐ Sub-contractor ☐ Key Personnel

RESPONDENT INFORMATION [completed by Reference Contact]

Company Name

Street Address

POC Name

City

Phone Number

State

Fax Number

Zip Code

Email

PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2 in the applicable text box OR in the Remarks section, below (text box will expand to whatever extent is necessary).

1
2
3
4
5
6
UNSATISFACTORY
MARGINAL
SATISFACTORY
VERY GOOD
EXCEPTIONAL
NEUTRAL
Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.
Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.
Performance met contractual requirements. There were some minor problems and corrective actions taken by the contractor are satisfactory.
Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems, which the contractor resolved in a timely, effective manner.
Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner.
No record of past performance or the record is inconclusive
The Contractor …
1
2
3
4
5
6
1.
Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

Narrative:

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

Narrative:

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

Narrative:

☐☐☐☐☐☐
4.
Home office participated in solving significant local problems.

Narrative:

☐☐☐☐☐☐
5.
Followed approved quality control plan.

Narrative:

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

Narrative:

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

Narrative:

☐☐☐☐☐☐
8.
Provided timely resolution of contract discrepancies

Narrative:

☐☐☐☐☐☐
9.
Identified problems as they occurred.

Narrative:

☐☐☐☐☐☐
10.
Suggested alternative approaches to problems.

Narrative:

☐☐☐☐☐☐
11.
Displayed initiative to solve problems.

Narrative

☐☐☐☐☐☐
12.
Developed realistic progress schedules.

Narrative:

☐☐☐☐☐☐
13.
Met established project schedules.

Narrative:

☐☐☐☐☐☐
14.
Provided timely resolution of warranty defects.

Narrative:

☐☐☐☐☐☐
15.
Was responsive to contract changes.

Narrative:

☐☐☐☐☐☐
16.
Provided adequate project supervision.

Narrative:

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

Narrative:

☐☐☐☐☐☐
18.
Paid subcontractors/suppliers in a timely manner.

Narrative:

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

Narrative:

☐☐☐☐☐☐
20.
Cooperated with Government personnel after award.

Narrative:

☐☐☐☐☐☐
21.
How would you rate the contractor's overall performance?

Narrative:

☐☐☐☐☐☐
22.
Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
☐YES
☐NO
23
Would you award another contract to this contractor? If not, please explain in “remarks.”
☐YES
☐NO
24
To the best of your knowledge, is the contractor rated in CPARS?
☐YES
☐NO

REMARKS (Please use as much space as is needed – the box will expand as you type).

Printed Name/ TitleSignature
Source Selection Sensitive-See FAR Part 3.104Page 22 of 32

Source Selection Information--See FAR 2.101 and 3.104

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