B08 Attachment 3 Past Performance Questionnaire.docx
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- Solicitation number
- 140F0221R0008
About this file
This document contains a past performance questionnaire for a design-build contract opportunity. The questionnaire requests information on the respondent's previous experience with design-build contracts, experience designing and building water control structures including box culverts and associated earthwork, and experience performing hydrologic and hydraulic design for drainage structures. Respondents are asked to provide details on three past contracts or subcontracts, including contracting agency, scope of work, role, subcontracting details, schedule and completion details, and any quality or safety issues encountered. The related federal contract opportunity is for canal drainage and water control structures at the OK-TISHOMINGO National Fish Hatchery, solicited by the U.S. Fish and Wildlife Service Region 2. Responses to the past performance questionnaire are required to be considered for this design-build contract opportunity.
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Attachment 3 page 1 of 4
TECHNICAL/PAST AND PRESENT PERFORMANCE QUESTIONNAIRE
Your Company Name:
Street Address:
Email Address:_____________________________________ City, State and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
| Company President: | Vice President: | |
| Dun & Bradstreet Number: | __ |
Is company; Sole Propriety [ ] Partnership [ ] Corporation [ ] Division [ ] N/A [ ]
2. PAST EXPERIENCE
a. Provide at least three examples each of past experience with Design-Build contracts done by designers and constructors.
b. Provide at least three examples each of past experience, and also technical qualifications of designers, including state registration, and constructors for designing and building water control structures including box culverts and associated earthwork similar to those in this project.
c. Provide at least three examples of past experience, and also technical qualifications, including state registration, of designers for performing hydrologic and hydraulic design for drainage structures similar to those in this project.
Note: Engineers and architects performing professional design work on this project shall be licensed in the state of Oklahoma per the Statement of Work.
Contractors may be required to possess and maintain state licenses, as required by Oklahoma state regulations. The following information is provided on construction contractor license requirements in Oklahoma:
Building and General Construction Contractors In Oklahoma, general contractors are not required to have state licenses to perform their construction services. This includes commercial or residential buildings, roads, bridges and highways, installation of residential and municipal utilities, industrial and oil field installations and other various projects. Likewise, state licenses are not required of subcontractors who perform general construction services on projects for general contractors. Such services, normally, include areas such as: site clearing and leveling, concrete stemming, framing, carpentry, drywall, painting, guttering, sodding, fencing, etc. Also, state licenses are not required for small general contractors or subcontractors who do commercial or residential renovation, remodeling and repair construction projects.
Out-of-state Contractors An out-of-state contractor who obtains a construction contract in Oklahoma is required to complete a special “Non-Resident Contractor” registration with the Oklahoma Tax Commission (OTC) prior to starting a project. For contracts in excess of $100,000, a bond for 10% of the amount is required to be posted (or the deposit of a cash equivalent amount). Information regarding the special registration and possible bonding is provided in OTC’s informational document, “Packet N.” The packet can be obtained off OTC’s website.
3. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS
Complete and submit the information requested on page 2-4 below on prime contracts or subcontracts completed or in progress. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress.
a. First Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | |
| Contract Number: | Contract/Subcontract Amount: $ |
Project Title and Location:
General Scope of Design Build Project:
Your Role (General Contractor [ ], Joint Venture [ ], Designer [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Were You Assessed Liquidated Damages? (If the answer to either Question is “Yes”, Explain:
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
b. Second Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | |
| Contract Number: | Contract/Subcontract Amount: $ |
Project Title and Location:
General Scope of Construction Project:
Your Role (General Contractor [ ], Joint Venture [ ], Designer [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Were You Assessed Liquidated Damages? (If the answer to either Question is “Yes”, Explain:
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
c. Third Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | |
| Contract Number: | Contract/Subcontract Amount: $ |
Project Title and Location:
General Scope of Construction Project:
Your Role (General Contractor [ ], Joint Venture [ ], Designer [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Were You Assessed Liquidated Damages? (If the answer to either Question is “Yes”, Explain:
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
4. Certification of Past and Present Performance Information:Type or Print Information
Name of Survey Preparer_______________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
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