Attachment C - Past Performance Questionnaire.docx
DOCX document 28 KB Posted
- Attached to
- C1DB--Remodel 2C Neurology Clinic
- Solicitation number
- 36C24624R0068
About this file
This document is a Past Performance Questionnaire that is being requested from the contractor's references as part of a federal contract opportunity for the Renovation of the 2C Neurology Clinic at the Richmond VA Medical Center.
The key details are: The contract opportunity is a 100% Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside to provide Architect-Engineering (AE) services for the renovation and remodel of the 2C Neurology area into administrative offices and exam rooms. Interested firms must be registered in the SBA's Veteran Small Business Certification (VetCert) database. Responses in the form of SF-330 submissions are due by 3:00 PM EDT on May 17, 2024. The estimated construction cost is between $1-2 million. The AE firm selected will be required to provide design services in multiple submission phases and coordinate closely with the VA Medical Center to minimize operational impacts during construction.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C24624R0068.docx | DOCX document | |
| Attachment A - Statement of Work.pdf | ||
| Attachment B - Selection Criteria.pdf | ||
| Attachment D - Location.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT C: PAST PERFORMANCE QUESTIONAIRE REQUEST LETTER
FROM:
[Insert Company Official Name, Title, and Company Name]
SUBJECT: Request for Past/Present Performance Information
[Insert Company Name] is currently responding to VHA Network Contracting Office 6 and Hampton VA Medical Center, regarding a Pre-Solicitation Notice (Request for SF-330s) for AE Renovate 2C Neurology Clinic. This request for SF-330s 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 3:00 PM EST, May 24th, 2024. Send completed questionnaires directly to Contract Specialist Aaron Holmes at aaron.holmes@va.gov and CC Contracting Officer, Madeline Lucena-Pulst at madeline.lucena-pulst@va.gov.
*Please DO NOT return the completed form to the Contractor requesting the reference. *
Past Performance Questionnaire
SECTION A.1: Contractor and Project Information (to be completed by the contractor (offeror) prior to sending to references.
A. Contractor’s name and address: _________________________________________
B. Project Owner -POC: _________________________________________
| C. Phone: | _________________________________________ | |
| D. Email Address: | _________________________________________ |
D. Contract Number: _________________________________________ E. Project Title/Desc of Work: _________________________________________
| _________________________________________ | ||
| F. Contract Type: | _________________________________________ | |
| G. Project Award Date: ______________ | Scheduled Completion Date: ________________ |
Current/Final Completion Date: ________________
H. Project Award Amount: ____________ Current/Final Project Amount: ________________ I. Contractor being evaluated performed as the: Prime Contractor Subcontractor Supplier
A.2: EVALUATED BY: (to be completed by Project Owner)
(Signature) (Date)
_____________________________________ Address: _____________________________ (Typed or Printed Name) _____________________________________ (Title)
(Phone/Fax/Email)
A
| B |
| C |
| D |
NA
| Substantial Confidence |
| Satisfactory Confidence |
| Limited Confidence |
| No |
Confidence
Unknown Confidence
| Based on the offeror’s performance record, there is a high expectation that the offeror will successfully perform. |
| Based on the offeror’s performance record, there is an expectation that the offeror will successfully perform. |
| Based on the offeror’s performance record, there is low expectation that the offeror will successfully perform. |
| Based on the offeror’s performance record, there is no expectation that the offeror will successfully perform. |
No performance record is identifiable, or the offeror’s performance record is so sparse that no rating can be reasonably assigned.
EVALUATION AREAS
I. Quality A B C D NA
| 1. |
| Contractor provided effective quality control and inspection procedures that resulted in a quality-finished project. |
| □ |
| □ |
| □ |
| □ |
| 2. |
| Contractor developed and submitted realistic progress schedules. |
| □ |
| □ |
| □ |
| □ |
| 3. |
| Contractor provided well researched and clearly identified submittals that matched contract requirements. |
| □ |
| □ |
| □ |
| □ |
| 4. |
| Contractor completed all work with good workmanship and in conformance with the specifications, resulting in minor, if any, punchlist items. |
| □ |
| □ |
| □ |
| □ |
| 5. |
| Contractor thoroughly reviewed drawings and specifications for accuracy, completeness, and compliance with contract requirements. |
| □ |
| □ |
| □ |
| □ |
II. Timely Performance A B C D NA
| 1. |
| Contractor met established project schedules to complete the project on time. |
| □ |
| □ |
| □ |
| □ |
| 2. |
| Contractor performed all work without the issuance of a cure notice or show cause letter. (If a notice was issued, please describe the circumstances on a separate sheet of paper and identify if liquidated damages were assessed.) |
| □ |
| □ |
| □ |
| □ |
| 3. |
| Contractor provided timely cost/design proposals. |
| □ |
| □ |
| □ |
| □ |
| 4. |
| Contractor submitted the progress schedule and interim progress reports as required in a timely manner and the schedule was approved prior to actual construction. |
| □ |
| □ |
| □ |
| □ |
| 5. |
| Contractor provided submittals on time as required. |
| □ |
| □ |
| □ |
| □ |
| 6. |
| Contractor provided payrolls for both their firm and their subcontractor’s employees as required and scheduled |
| □ |
| □ |
| □ |
| □ |
| 7. |
| Contractor provided timely resolution of all punchlist items. |
| □ |
| □ |
| □ |
| □ |
III. Management Effectiveness A B C D NA
| 1. |
| Contractor provided experienced qualified managers and supervisors with the technical and administrative abilities needed to meet contract requirements. |
| □ |
| □ |
| □ |
| □ |
| 2. |
| Contractor hired quality subcontractors and effectively managed and coordinated their work. |
| □ |
| □ |
| □ |
| □ |
| 3. |
| Contractor hired, maintained, and replaces as necessary, qualified personnel and subcontractors/suppliers. |
| □ |
| □ |
| □ |
| □ |
| 4. |
| Contractor ensured the site manager had sufficient authority to make decisions and take actions during project performance to keep the project on schedule. |
| □ |
| □ |
| □ |
| □ |
| 5. |
| Contractor provided timely and satisfactory response to warranty issues after project completion. |
| □ |
| □ |
| □ |
| □ |
| 6. |
| Contractor paid employees/subcontractors/suppliers as required. |
| □ |
| □ |
| □ |
| □ |
| 7. |
| Contractor cooperated to resolve problems, attended meetings and maintained communication to assure satisfactory resolution. |
| □ |
| □ |
| □ |
| □ |
IV. Compliance with Safety Standards A B C D NA
| 1. |
| Adequacy of Safety Plan |
| □ |
| □ |
| □ |
| □ |
| 2. |
| Implementation of Safety Plan |
| □ |
| □ |
| □ |
| □ |
V. Overall Performance A B C D NA
| 1. |
| Please rate the contractor’s overall performance |
| □ |
| □ |
| □ |
| □ |
Additional Information:
(1) Identify the contractor's overall strengths and weaknesses.
(2) Given the choice, would you award to this contractor again?
(3) Are you aware of any other contracted efforts performed by this contractor similar in nature to this contract? Please identify contract/program and point of contact.
(4) Is there anyone else we should send this questionnaire to? Please identify by name, organization, and phone number.
Thank you for taking the time to complete this questionnaire.
File details come from the government source that posted it. Updated .