WFL_AE_Past_Performance_Questionnaire.pdf

Source Selection Information See FAR 2.101 and 3.104

(Applicable when filled-in)

Form P1 - Past Performance Questionnaire (Design), Page 1

(Submitted by Owner/Agency)

REQUEST FOR PAST PERFORMANCE

Western Federal Lands Highway Division (WFLHD) is currently in the process of soliciting qualifications for an Architect and Engineering Services Multi Discipline IDIQ. Specifically, they are looking for past performance information on design projects completed since January 2009.

In order for WFL to complete its evaluation, please complete and submit the attached questionnaire directly to WFL no later than the proposal due date which is currently December 15, 2014. The completed questionnaire may be mailed, e-mailed or faxed to:

Attn: Susan Yenne

(Mailroom – Do not open) Western Federal Lands Highway Division 610 East Fifth Street Vancouver WA 98661-3801

FAX: (360) 619-7932 (ATTN: Susan Yenne) E-MAIL: WFL_AEIDIQ@dot.gov (ATTN: Susan Yenne) Verfication of receipt phone number: 360.619.7601or 360.619.7597

Form P1 - Past Performance Questionnaire (Design), Page 2

Directions to Owner/Agency: Please complete this form and submit it directly to Susan Yenne via mail, e-mail or fax.

To verify receipt, call 360.619.7601 or 360.619.7597.

MAIL E-MAIL FAX

Attn: Susan Yenne (Mailroom – Do not open)

Western Federal Lands Highway Division 610 East Fifth Street

Vancouver WA 98661-3801

WFL_AEIDIQ@dot.gov ATTN: Susan Yenne

(360) 619-7932 (ATTN: Susan Yenne)

Part A - General Information (to be completed by the design firm):

Design Firm’s Name & Address

Owner/Agency

Contact Name: Contact Phone:

Project Title

Contract Number

Project Role

(__)Primary Consultant (__) Sub-consultant; Value of Subcontract $___________________

Project Location (Town/State/Forest…)

Description of Work provided by the Design Firm

Contract Information for project listed above (to be completed by the Owner/Agency):

Engineer’s Estimate of Project : Contract Award Date:

Original Completion Date: Final Completion Date:

Initial A/E Contract Amount Final A/E Contract Amount

Was a contractor evaluation prepared? __ Yes __ No If yes what was the overall rating?

Form P1 - Past Performance Questionnaire (Design), Page 3

Evaluation Factor Rating System. Please provide ratings and comments regarding the Firm’s performance in each area below using the following ratings:

N/A=Not Applicable U=Unsatisfactory M=Marginal S=Satisfactory V=Very Good E=Exceptional

For ratings of “Unsatisfactory” and “Marginal” please provide a brief explanation in the remarks section.

Rate the quality of A/E services by discipline

Structural N/A U M S V E

Civil N/A U M S V E

Surveying, Mapping, and Geospatial Information Services N/A U M S V E

Cost Estimating N/A U M S V E

Value Engineering N/A U M S V E

Environmental Engineering N/A U M S V E

Geotechnical Engineering N/A U M S V E

Hydrology N/A U M S V E

Geology N/A U M S V E

Risk Assessment N/A U M S V E

Rate the Design Phase or Engineering Services

Thoroughness of Site Investigation N/A U M S V E

Quality control Procedures and Execution N/A U M S V E

Plans/Specs Accurate and Coordinated N/A U M S V E

Plans Clear and Detailed Sufficiently N/A U M S V E

Management and Adherence to Schedules N/A U M S V E

Meeting Cost Limitations N/A U M S V E

Suitability of Design or Study Results N/A U M S V E

Solution Environmentally Suitable N/A U M S V E

Cooperativeness and Responsiveness N/A U M S V E

Quality of Briefing and Presentations N/A U M S V E

Innovative Approaches/Technologies N/A U M S V E

Other Meeting Small Disadvantaged Business Subcontracting Goals N/A U M S V E

Additional Comments: