EXHIBIT A - Past Performance Relevancy Questionnaire 36C24424R0001 _ Replace Steam System.pdf

PDF 174 KB Posted

Attached to
Z1DA--NRM | 503-19-112 Replace Steam System Project (VA-24-00009779) Federal contract opportunity
Solicitation number
36C24424R0001
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 4

About this file

This document contains an exhibit for a past performance relevancy questionnaire related to a solicitation to replace a steam system. The questionnaire requests information on up to three relevant past projects as a prime or subcontractor within the past five years, including contract details, descriptions of work performed, and references. It also requests names of up to three subcontractors in various specialty areas that will be used if awarded the contract. The related federal contract opportunity is to replace the steam system at the Veterans Affairs Medical Center in Salem, Virginia, with responses due by January 29, 2020 and work expected to be completed by November 30, 2020. Pricing will be fixed price. The solicitation is set aside for service-disabled veteran-owned small businesses and is being issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 4.

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Text version

EXHIBIT A PERFORMANCE RELEVANCY QUESTIONNAIRE

PART 1: Prepare no more than three (3) Part 1 forms:

Provide the following information requested in this format for each of the projects/contracts being described. Projects may be on going and cannot have been completed any later than 5 years prior to the solicitation issue date. Provide frank, concise comments regarding YOUR PERFORMANCE on the contracts you identify. Use additional space as required.

A. Offeror (Your) Name (Company/Division):

B. Project/Contract Title:

C. Contract Specifics:

1. Description of Effort as Prime or _Subcontractor

2. Contract Number

3. Original Contract $ Value Current/Final Contract $ Value

4. If amounts in 3 above are different, provide a brief description of the reason:

5. Completion Date:

1. Original Date:

2. Current Schedule: _____________________

3. Estimate/Final Completion Date:

4. Primary cause for Contract Modifications

D. Provide detailed description of the work performed under the contract and describe why you believe the work is very relevant, relevant or semi-relevant to this solicited project.

(Use as much space as necessary)

In addition, address the following

1. Describe the specific elements of the work performed by your firm.

2. Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on projects awarded under this solicitation. Should you intend to use these same subcontractors, please list their company names and described their principal areas of work that they will perform.

3. Address any technical areas about this project you consider uniquely relevant to this solicitation.

E. Point of Contact for Owner/Government agency Contracting Officer and or inspector (COR / COTR); include a current phone number and email address for each.

End of Part 1- Questionnaire Requirements – Prepare and send Exhibit B Package to the reference(s) for each of the no more than three Construction Projects, or Specialty Trade if applicable provided in Exhibit A, Part 1. See below for Exhibit A, Part 2.

Part 2, Additional offeror information required.

A. Name subcontractors and/or Teaming Partners to be utilized on this contract. Multiple subcontractors may be named for the same discipline but are limited to a maximum of three (3) subcontractors per discipline. As a minimum, provide the name(s) of subcontractors to be utilized in the following areas:

(Specialty Trades will address their specific trade for any major subcontractor or Teaming partner)

PART 1: Prepare no more than three (3) Part 1 forms:
End of Part 1- Questionnaire Requirements – Prepare and send Exhibit B Package to the reference(s) for each of the no more than three Construction Projects, or Specialty Trade if applicable provided in Exhibit A, Part 1. See below for Exhibit A, Part 2.

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