Attachment C_Past Performance Questionnaire.pdf

36C24624R0011

590-24-300, Correct Water System Distribution

PAST PERFORMANCE QUESTIONAIRRE REQUEST LETTER

FROM:

Cilena Adams Network Contracting Office 6-RPO EAST 100 Emancipation Drive, Bldg 27 Hampton, VA 23667

SUBJECT: Request for Past/Present Performance Information

1. You have been identified as a point of contact for a past and/or present performance evaluation of ______________________________________. This firm is currently being considered for a contract at the Hampton VA Medical Center located in Hampton, VA.

2. Your prompt attention to this survey will be greatly appreciated. Please be sure to e-mail the completed questionnaire directly to Cilena Adams at Cilena.Adams@va.gov no later than the proposal due date.

Questionnaires shall not be sent back to the Contractor. If you have any questions or concerns regarding this request, please contact Cilena Adams by email at Cilena.Adams@va.gov.

mailto:Nicholas.Ruppert@va.gov

590-24-300, Correct Water System Distribution

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)

590-24-300, Correct Water System Distribution

A = Exceptional 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.

B = Very Good 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.

C = Satisfactory 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.

D = Marginal 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.

E = Unsatisfactory 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.

NA = N/A Not applicable or rater has not observed performance in this area.

EVALUATION AREAS

I. Quality A B C D E 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 E 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. □ □ □ □ □ □

590-24-300, Correct Water System Distribution

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 E 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 E NA

1. Adequacy of Safety Plan □ □ □ □ □ □

2. Implementation of Safety Plan □ □ □ □ □ □

V. Overall Performance A B C D E 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.

590-24-300, Correct Water System Distribution

36C24624R0011

(4) Is there anyone else we should send this questionnaire to? Please identify by name, organization, and phone number.

(If more comment space is needed, please attach pages.)

Thank you for taking the time to complete this questionnaire.