B08 Attachment 3 Past Performance Questionnaire.docx

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:

Is company; Sole Propriety [ ] Partnership [ ] Corporation [ ] Division [ ] N/A [ ]

2. PAST EXPERIENCE

1. Technical/Past and Present Performance Questionnaire document with all the required information must be completed: The Government will evaluate the quality and extent of offeror's experience deemed recent and relevant to the requirements of this RFP. The Government will use the information submitted by the offeror to evaluate them according to Section M of this RFP.

Sub-Factor 1. Project Approach:

1. Evaluation of the narrative that describes your firm’s approach to completing this project as shown on the drawings and contained in the specifications, to include:

0. Evaluation of logistics, mobilization, safety, and quality control. Clearly explain the plan for performance of all work elements included in the specifications and drawings, including reference to all material, labor, equipment and supervision requirements to perform required fieldwork and subsequent closeout actions.

0. Evaluation of any potential obstacles, pitfalls, and assumptions that your firm must consider in advance to guarantee the successful completion of this project, and what considerations you have taken into account to resolve these issues if they do in fact arise.

0. Evaluation of prime contractors who are proposing from out of the local area or out of State, which clearly depict the project approach, are going to accomplish this work in a semi-remote area and what local resources they have commitments from in order to assure the work is accomplished as proposed.

1. Evaluation of the list of the equipment you will need to perform this project and whether or not your firm has this equipment or how you plan to acquire it.

1. Evaluation of what work will be performed by your company and what work will be performed by subcontractor(s). Provide an explanation of any major subcontractor's roles in the execution of the project. Include details as to their responsibilities for execution, submittals etc. Describe what, if any, local resources will be used in order to accomplish the work. How your firm will accomplish this work in a semi-remote area and what local resources commitments from local sources, in order to assure the work is accomplished as proposed.

Sub-Factor 2. Proposed Construction Progress Schedule:

Evaluation of the Proposed Progress Schedule, which shows how the solicitation requirements will be accomplished. Included pre-construction submittals and ordering of long-lead items, any needed permits, mobilization, construction, and closeout actions required in accordance with the project specifications and drawings. Showing all the phases of the project, and clearly identify all major activities together with milestone events.

Sub-factor 3: Organizational Capabilities and Past Performance

FWS is interested in determining that the successful offeror and their proposed subcontractors have the necessary experience, qualifications, and resources to perform and completely construct this project on time and within budget.

1. Evaluation of your organizational structure and which identifies all key personnel with a description of their work experience relating to projects similar in scope to this project. At a minimum, this must include key personnel such as the Project Manager, Quality Control Manager, and Site Superintendent. These positions shall be filled by three different individuals and the Quality Control Manager should not report directly to the Site Superintendent. The document shall also describe how communications with the Government shall be addressed, focusing on problem avoidance and problem resolution.

1. Evaluation of the brief overview of your firm's capabilities, or your major subcontractors, and relative experience in construction of civil engineering type projects of similar magnitude, complexity and scope, and how these correlates to successful completion of this project.

1. Evaluation of the brief history and overview of your company and its organizational structure, including number of years in business, along with a list of similar projects completed within the last 5 years and points of contact and phone number of references.

1. Evaluation of the list of subcontractors with addresses, phone numbers, and references of similar type work to be utilized on this project along with an explanation of what key roles they will play.

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:

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:

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:

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__________________________________________