Attachment L2 - Past Performance Questionnaire.docx
DOCX document 58 KB Posted
- Solicitation number
- 75N99020R00033
About this file
This document contains a past performance questionnaire template for evaluation of roof replacement, restoration, maintenance, and repair services. The contractor must provide all labor, materials, equipment, supervision, and related services to perform full roof replacement and ongoing maintenance for buildings at the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina. The evaluation questionnaire is sent to previous customers of the contractor to assess performance across factors such as quality, timeliness, responsiveness, subcontract management, design, and cost control. Respondents are asked to rate performance as unsatisfactory, marginal, satisfactory, outstanding or non-applicable, and provide explanations for any less than satisfactory ratings. The completed questionnaires should be returned to the identified point of contact to inform the full roof replacement services procurement for the NIEHS campus under solicitation number 75N99020R00033 by the Department of Health and Human Services National Institutes of Health Construction.
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Text version
Past Performance Questionnaire
PART A – CONTRACTOR INFORMATION (to be completed by the contractor requesting evaluation prior to mailing) A. Contractor’s name and address:
B. Contractor’s point of contact:
C. Phone number (with area code):
D. Contract Number:
E. Project Title:
F. Work Type (choose one): ____ Design-Build ____ Construction Only
G. Project Award Amount: $______________________ Final Project Amount: $________________________
H. Contractor performed as the (select one): ____ Prime Contractor ____ Joint Venture ____ Subcontractor
I. List all Major Subcontractors (performed more than 5% of the work):
| Name of the Firm |
| Work Performed |
| Subcontract Amount |
| Point of Contact |
| Phone |
J. Authorization is hereby granted to provide the information requested in PART B of this Questionnaire.
(Signature)
(Name and Title of Authorizing Official) (Date)
PART B – SECTION 1: RESPONDENT INFORMATION (to be completed by the evaluator) A. Organization’s name: _____________________________________________________ Date:
B. Evaluator’s name and title:
C. Evaluator’s contact information (phone and email):
D. Number of years and relationship of evaluator to the subject contract:
E. Description of Work performed under this project:
F. Project Award Date: _____________________________ Original Contract Completion Date: _______________________________
Final Contract Completion Date: ___________________ Turnover/Acceptance Date: ______________________________________ Please explain any differences between the Original, Final, and/or Turnover dates: __________________________________________
G. Has a Contract Performance Evaluation been submitted and accepted for the project identified in Part A (yes/no)? _______________ (If YES then a copy of the evaluation may be submitted in lieu of this Questionnaire.)
PART B – SECTION 2: PERFORMANCE INFORMATION (Choose the letter on the scale that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OTHER THAN SATISFACTORY IN THE REMARKS SECTION.)
| U |
| M |
| S |
| O |
| N/A |
| Unsatisfactory |
| Marginal |
| Satisfactory |
| Outstanding |
| Not applicable |
| Based on the contractor’s performance record, the contractor did not successfully perform the required effort. |
| Based on the contractor’s performance record, the contractor was somewhat successful in performing the required effort. |
| Based on the contractor’s performance record the contractor successfully performed the minimum required effort. |
| Based on the |
contractor’s performance record the contractor was highly successful in performing the required effort.
No or very limited performance information is available therefore no meaningful rating can be reasonably assigned.
Evaluation Areas
1. CUSTOMER SATISFACTION:
Would you have any reservations in awarding another contract to this Contractor or working with this Contractor on any future contracts?
| YES |
| NO |
N/A
2. QUALITY:
| a |
| Contractor provided effective quality control and/or inspection procedures to meet |
contract requirements
| U |
| M |
| S |
| O |
N/A
| b |
| Contractor provided well researched and clearly identified submittals that matched |
contract requirements
| U |
| M |
| S |
| O |
N/A
| c |
| Contractor completed all work with good workmanship and in conformance with |
the specifications
| U |
| M |
| S |
| O |
N/A
| d |
| Contractor corrected deficiencies in a timely manner and pursuant to their quality |
control plan
| U |
| M |
| S |
| O |
N/A
3. TIMELINESS:
| a |
| Contractor met established project milestones without excessive revisions |
| U |
| M |
| S |
| O |
N/A
| b |
| Contractor provided timely cost/design proposals |
| U |
| M |
| S |
| O |
N/A
| c |
| Contractor submitted adequate progress schedules and progress reports as required |
| U |
| M |
| S |
| O |
N/A
| d |
| Contractor provided on-time submittals as required |
| U |
| M |
| S |
| O |
N/A
| e |
| Contractor provided payrolls for both their employees and their subcontractors |
employees as required
| U |
| M |
| S |
| O |
N/A
| f |
| Contractor provided timely resolution of all punch list items |
| U |
| M |
| S |
| O |
N/A
4. RESPONSIVENESS:
| a |
| Contractor acted promptly to resolve problems, ensuring compliance with contract |
requirements and safety regulations
| U |
| M |
| S |
| O |
N/A
| b |
| Contractor was reasonable and cooperated to resolve problems, attended meetings |
as needed, and maintained communication with the government to keep the project on schedule or minimize delays
| U |
| M |
| S |
| O |
N/A
| c |
| Contractor identified problems as they occurred; suggested approaches to the |
problems; displayed initiative to solve problems; and performed as a Team Member
| U |
| M |
| S |
| O |
N/A
| d |
| Contractor responded to warranty issues within the time frames specified in the |
contract
| U |
| M |
| S |
| O |
N/A
5. SUBCONTRACTS AND MANAGEMENT:
| a |
| Contractor successfully partnered with all stakeholders to meet contract objectives |
| U |
| M |
| S |
| O |
N/A
| b |
| Contractor provided experienced/qualified managers and supervisors with the |
technical and administrative abilities needed to meet contract requirements
| U |
| M |
| S |
| O |
N/A
| c |
| Contractor hired quality subcontractors and effectively managed and coordinated |
their work
| U |
| M |
| S |
| O |
N/A
| d |
| Contractor hired, maintained, and replaced as necessary, qualified personnel and |
subcontractors/suppliers
| U |
| M |
| S |
| O |
N/A
| e |
| Contractor ensured the project manager had sufficient authority to make decisions |
and take actions during project performance to keep the project on schedule
| U |
| M |
| S |
| O |
N/A
| f |
| Contractor ensured site superintendent and quality control representative were |
consistently present on site when work was performed
| U |
| M |
| S |
| O |
N/A
| g |
| Contractor paid employees/subcontractors/suppliers as required |
| U |
| M |
| S |
| O |
N/A
SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104
75N99020R00033 Attachment L2
SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104
6. DESIGN:
| a |
| Contractor provided complete, supportable, technically sound designs for the |
project
| U |
| M |
| S |
| O |
N/A
| b |
| Contractor demonstrated the ability to incorporate user’s requirements into the |
design
| U |
| M |
| S |
| O |
N/A
| c |
| Contractor completed designs that were constructed in the same manner as they |
were designed
| U |
| M |
| S |
| O |
N/A
7. CHANGE/COST CONTROL:
| a |
| Contractor responsive to contract changes and provided accurate, reasonable and |
supportable cost proposals
| U |
| M |
| S |
| O |
N/A
| b |
| Contractor demonstrated the ability to control costs and/or design projects or |
modifications within the magnitude specified
| U |
| M |
| S |
| O |
N/A
| c |
| Contractor validated subcontractor cost proposals prior to submission |
| U |
| M |
| S |
| O |
N/A
PART B – SECTION 3: REMARKS
1. Customer Satisfaction – Please explain your response to Question 1 above:
2. Quality:
3. Timeliness:
4. Responsiveness:
5. Subcontracts and Management:
6. Design:
7. Change/Cost Control:
PART B – SECTION 4: GOVERNMENT CONTRACTS ONLY
Was the contractor ever issued a cure or show cause notice under the referenced contract? No Yes If yes, explain the outcome: ______________________________________________________________________________________ Thank you for your prompt response and assistance!
Please return this completed questionnaire to:
Daniel F. Burk at daniel.burk@nih.gov
File details come from the government source that posted it. Updated .