Form_P1-PastPerformance-Design.pdf

Design‐Build Request for Qualifications (RFQ) Appendix A

Form P1 - Past Performance Questionnaire (Design), Page 1 (Submitted by Owner/Agency)

REQUEST FOR PAST PERFORMANCE

Type of Contract: The Federal Highway Administration (FHWA) is currently in the process of soliciting qualifications for a design-build project.

What do you need to do? WFLHD is looking for past performance information on design projects completed since January 1, 2007 or that are ongoing with at least 75% of the design work complete as of the date this questionnaire is filled out.

Please complete and submit the attached questionnaire directly to FHWA no later than July 2, 2015. The completed questionnaire may be mailed, e-mailed or faxed to:

Mail or Delivery Address:

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.Construction@dot.gov (ATTN: Susan Yenne) Telephone verification of receipt: 360.619.7601

Source Selection Information See FAR 2.101 and 3.104

(Applicable when filled-in)

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.

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.Construction@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 Contractor:

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

Engineer’s Estimate of Construction Project:

A/E Contract Start Date:

Original A/E Completion Date:

Final A/E Completion Date:

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

If the design is ongoing, has 75% of the design been completed? __ Yes __ No

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

Source Selection Information See FAR 2.101 and 3.104

(Applicable when filled-in)

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: