Attachment E - Past Performance Questionnaire.docx
DOCX document 66 KB Posted
- Attached to
- Z2DA--Renovate PACU Federal contract opportunity
- Solicitation number
- 36C24621R0127
About this file
This document contains a past performance questionnaire and details of a related federal contract opportunity for renovation and expansion of a Post-Anesthesia Care Unit (PACU) at the Durham VA Medical Center in Durham, North Carolina. The contract opportunity involves gut renovation of approximately 4,400 square feet of space and expansion of the PACU into an adjoining pain care clinic to provide sixteen recovery bays, one isolation room, and maintain patient flow from twelve operating rooms. The estimated construction magnitude is between $2 million and $5 million. The solicitation is anticipated as a total service-disabled veteran-owned small business set-aside with a NAICS code of 236220 and size standard of $16.5 million. The solicitation is expected to be available on or around September 17, 2021 with proposals due approximately 30 days after issuance.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Renovate PACU - RFI Response.pdf | ||
| 00 SOW - Updated.pdf | ||
| 36C24621R0127 0001.docx | DOCX document | |
| Site Visit Sign-In Sheet - Renovate PACU.pdf | ||
| Attachment F - Base Proposal Item Price Breakdown.xlsx | XLSX spreadsheet | |
| Attachment A - Drawings.pdf | ||
| 36C24621R0127_1.docx | DOCX document | |
| Attachment B - Specifications - VOL. 1.pdf | ||
| Attachment D - Wage Determination NC20210028.pdf | ||
| Attachment C - Specifications - VOL. 2.pdf |
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Text version
EXHIBIT A : PAST PERFORMANCE QUESTIONAIRRE REQUEST LETTER
FROM:
Schon M. Zwakman Network Contracting Office 6 - RPO EAST 508 Fulton St, Bldg 6 Durham, NC 27705
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 Durham VA Medical Center located in Durham, NC.
2. Your prompt attention to this survey will be greatly appreciated. Please be sure to e-mail the completed worksheet directly to Schon Zwakman at schon.zwakman@va.gov and Marty Bost at marty.bost@va.gov NLT proposal due date.
Questionnaires shall not be sent back to the Contractor. If you have any questions or concerns regarding this request, please contact Schon Zwakman by email at schon.zwakman@va.gov or Marty Bost at marty.bost@va.gov.
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. |
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| 2. |
| Contractor developed and submitted realistic progress schedules. |
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| 3. |
| Contractor provided well researched and clearly identified submittals that matched contract requirements. |
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| 4. |
| Contractor completed all work with good workmanship and in conformance with the specifications, resulting in minor, if any, punchlist items. |
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| 5. |
| Contractor thoroughly reviewed drawings and specifications for accuracy, completeness, and compliance with contract requirements. |
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II. Timely Performance A B C D NA
| 1. |
| Contractor met established project schedules to complete the project on time. |
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| 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.) |
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| 3. |
| Contractor provided timely cost/design proposals. |
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| 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. |
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| 5. |
| Contractor provided submittals on time as required. |
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| 6. |
| Contractor provided payrolls for both their firm and their subcontractor’s employees as required and scheduled |
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| 7. |
| Contractor provided timely resolution of all punchlist items. |
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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. |
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| 2. |
| Contractor hired quality subcontractors and effectively managed and coordinated their work. |
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| 3. |
| Contractor hired, maintained, and replaces as necessary, qualified personnel and subcontractors/suppliers. |
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| 4. |
| Contractor ensured the site manager had sufficient authority to make decisions and take actions during project performance to keep the project on schedule. |
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| Contractor provided timely and satisfactory response to warranty issues after project completion. |
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| Contractor paid employees/subcontractors/suppliers as required. |
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| Contractor cooperated to resolve problems, attended meetings and maintained communication to assure satisfactory resolution. |
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IV. Compliance with Safety Standards A B C D NA
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| Adequacy of Safety Plan |
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| Implementation of Safety Plan |
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V. Overall Performance A B C D NA
| 1. |
| Please rate the contractor’s overall performance |
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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.
(If more comment space is needed, please attach pages.)
Thank you for taking the time to complete this questionnaire.
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