ATTACHMENT B Past Perfermance Questionnair-.docx

ATTACHMENT B

Past Performance Questionnaire

(Include this attachment if past performance questionnaires are requested in the solicitation and evaluated)

NOTE: The past performance questionnaire is optional and provided for illustrative purposes only.

PACKAGE INFORMATION AND FORMS

Instructions to Offeror for sending Reference Questionnaire Forms: Prepare and send a reference questionnaire package for each project listed on your Attachment B, Performance Relevancy Questionnaires. You are encouraged to send a questionnaire to other clients of contracts listed in your “List of projects”. For Government contracts, send to Contracting Officer or Technical Representative. For commercial references send to personnel with duties similar to those for Government contracts. It is your responsibility to follow-up and to encourage your references to send in their questionnaire. If you have multiple references at one location, send one cover letter and questionnaire for each contract you want a reference for. Your questionnaire package should contain the following.

· Cover Letter (See attached Sample)

· Respondent Identification and Ratings. Offeror should put name in spaces indicated and ensure it is on every page for identification purposes

· Suggested – Pre-Addressed stamped envelope to return to Contracting Officer.

OFFEROR SHOULD PLACE THEIR NAME ON TOP OF EACH QUESTIONNAIRE PAGE!!!

OFFEROR SHOULD DELETE THESE INSTRUCTIONS BEFORE SENDING OUT QUESTIONNAIRES

SAMPLE COVER LETTER

AND

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

Your Company Letterhead

Date: _________________

To: ______________________________________

We have listed your firm as a reference for the work we have performed for you as listed below. Our firm has submitted a proposal under a project advertised by the Department of Veterans Affairs, Office of Construction & Facilities Management. In accordance with Federal Acquisition Regulations (FAR), they will evaluate our firm's past performance. Your candid response to the attached questionnaire will assist the evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible. Space is provided for comments. Understand that while the responses to this questionnaire may be released to the offeror, FAR 15.306(e)(4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained. Only one response from each office is required.

Please send your completed questionnaire to the following address to arrive NOT LATER THAN <Add Due Date>. Do not return them to our company. NOTE: ELECTRONICALLY SUBMIT QUESTIONNAIRES BY EMAIL TO THE CONTRACTING OFFICER.

or email to: Katie.Washington@va.gov and Derek.underwood2@va.gov

If you have questions regarding the attached questionnaire, or require assistance, please contact Katie Washington at 202-821-2620.

Thank you for your assistance.

Katie C. Washington

RESPONDENT IDENTIFICATION AND RATINGS

(Part 1 Contractor submitting Proposal fill-in)

Reference is provided for: ____________________________________

Contract Number or Project Title___________________________________________ Date of Award/Completion Date______________________________________________________ Location_________________________________________________________________________ Dollar Amount____________________________________________________________________ Brief Description of work and your role in the referenced contract: ___________________________

(Part 2 Person providing Reference) Reference is provided by: ____________________________

Company/Agency: _________________________________________________________________ Business Address; ________________________________________________________________ Telephone Number: _______________________________________________________________ E-Mail Address: __________________________________________________________________ Relationship to Contract: ___________________________________________________________ If information in Part 1 is not accurate, please indicate.

To obtain an electronic version of the form please contact: katie.washington@va.gov .

THE QUESTIONNAIRE SHOULD BE SUBMITTED BY THE FOLLOWING MEANS: Via email to the email address shown above.

Mark cover sheet: (Attention: Solicitation 36C10F19R0065 “Source Selection Sensitive Information”)

PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

Phone Number: Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain) 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:

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:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING DEFINITION NOTE

There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

ATTACHMENT B -36C10F19R0065

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance)

E VG S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

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

E VG S M U N

3. CUSTOMER SATISFACTION:

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)

E VG S M U N

4. MANAGEMENT/ PERSONNEL/LABOR

5. COST/FINANCIAL MANAGEMENT

No

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

No

6. SAFETY/SECURITY

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.)

E

VG

S

M

U

N

7. GENERAL

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

E

VG

S

M

U

N

No

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

Source Selection Information – See FAR 2.101 and 3.104