Attachment A - Past Performance Questionnaire AE Nurse Call System slg.pdf

SOLICITATION ATTACHMENT - PAST PERFORMANCE QUESTIONNAIRE AND

COVER LETTER

Complete one set of letters and forms for at least three (3) projects identified in your firm’s SF 330 Section F, Example Projects Which Best Illustrate Proposed Team’s Qualifications for This Contract. Additional space or blank sheets may be added to answer any question.

Transmittal Letter to Accompany Past Performance Questionnaire

FROM: [Insert Company Official Name, Title, and Company Name]

SUBJECT: Past Performance Questionnaire for Contract(s):

[Insert Company Name] is currently responding to VHA Network Contracting Office 6 and the Charles George VA Medical Center, regarding a request for SF 330, Architect/Engineer Qualifications for Project 637-22-105, A/E Replace Nurse Call System. This Request for SF 330’s requires respondents to identify customers and solicit their response regarding [Insert Company Name] performance.

[Insert Company Name] is providing past performance data to VHA Network Contracting Office 6 relating to our performance on contract [Insert contract name/number] and have identified [Insert name of reference] as the point of contact for this contract.

The request for SF 330 instructs that respondents provide customers with the attached questionnaire. Please complete the questionnaire (Sections B and C) and return it by no later than 10:00am EST, September 23, 2021. Return the completed questionnaire directly to the Government Contract Specialist, Shirley Gregory, via email at:

Shirley.Gregory@va.gov.

*Do not return this form to the AE firm requesting the reference.*

A. GENERAL INFORMATION A-E

FIRM TO BE EVALUATED:

Firm Name:

Address:

DUNS Number:

Project Title: _____________________________________

Description of Project:

Description of A-E Firms’ Responsibilities:

Contract Number: ______________________ Dollar Amount: ______________________

Contract Period of Performance: _______________________

The A-E Firm performed as the Prime Contractor Sub-Contractor/Consultant/Team Member

Percent of work performed by A-E Firm:

B. EVALUATOR INFORMATION:

Evaluator’s Company or Agency Name:

Company or Agency Address:

Evaluator’s Name:

Title of Evaluator:

Telephone:

E-mail:

C. PERFORMANCE INFORMATION: Choose the appropriate rating that most accurately describes the A/E’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ALL RATINGS OF Marginal or Unsatisfactory on page 7 under Narrative Summary.

Exceptional (5) Very Good (4) Satisfactory (3) Marginal (2) Unsatisfactory (1) N/A

-Performance meets or met contractual requirements and exceeds or exceeded many of your company’s expectations. The contractual performance reflects or reflected few minor problems and corrective actions taken by the contractor appear to be highly effective or corrective actions taken were effective.

-Performance meets or met contractual requirements and exceeds or exceeded some of your company’s expectations. The contractual performance reflects or reflected some minor problems and corrective actions being taken by the contractor appear to be effective or Corrective actions taken were effective.

-Performance meets or met contractual requirements. The contractual performance reflects or reflected some minor problems.

Corrective actions being taken by the contractor appear to be effective or Corrective actions taken were effective.

-Performance does or did not meet some contractual requirements. The contractual performance reflects or reflected serious problems(s) for which the contractor has not yet identified acceptable corrective actions or did not provide acceptable corrective actions.

-Performance does or did not meet most contractual requirements and recovery is not likely or did not occur. The contractual performance contains or contained serious problem (s) for which the contractor’s corrective actions appear ineffective or were ineffective.

-Not applicable or rater has not observed performance in this area.

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

Number of A/E Design Errors & Omissions on Project: _______________ Increased Project Cost Due to A/E Design Errors & Omissions:_______________

NARRATIVE SUMMARY REGARDING PERFORMANCE:

D. SEND COMPLETED QUESTIONNAIRE, VIA EMAIL, TO:

Shirley Gregory, Contract Specialist Email: Shirley.Gregory@va.gov VISN 6 Networking Contracting Office (NCO 6)