EXHIBIT A PERFORMANCE RELEVANCY SURVEY.docx

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Attached to
Misc. Generator Repairs and Improvements Federal contract opportunity
Solicitation number
36C25621R0179
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16

About this file

This document contains an exhibit for evaluating past performance relevance on federal contracts. It requests information on specific past contracts for generators repairs and improvements. Offerors must provide details of up to five relevant past projects as a prime or subcontractor within the last five years. This includes the contract description and value, completion schedule, reasons for modifications or delays, and liquidated damages. A performance relevance rating of very relevant, relevant, somewhat relevant, or not relevant must be selected along with an explanation. References must also be included. Additional required information involves any liquidated damages assessed in the last five years, corrective actions taken on prior issues, awards, and unique skills. This procurement is a total Service-Disabled Veteran-Owned Small Business set-aside for miscellaneous generator repairs and improvements at the Gulf Coast Veterans Health Care System in Pensacola, Florida.

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FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Project: 520-22-166 Miscellaneous Generator Repairs and Improvements 36C25621R0179

EXHIBIT A

PERFORMANCE RELEVANCY SURVEY

PART 1: Provide the following information requested in this format for each of the projects/contracts you intend to have considered for evaluation. Projects may be on-going and cannot have been completed more than 5 years prior to the proposal issuance. Provide frank, concise comments regarding YOUR PERFORMANCE on the contracts you elect to reference.

A. Offeror Name (Company/Division):

B. Project/Contract Title:

C. Location of Project:__________________________________________________________________ D. 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. Was project completed on time: Yes ( ) No ( )

6. Completion Date(s):
a. Original Date:

b. Current Schedule:

c. Estimated/Final Completion Date:
d. Primary Cause for Contract Modifications:

e. Reason for delay if applicable:____________________________________________________

f. Any liquidated damages: Yes ( ) No ( )

g. CPARS available: Yes ( ) No ( ) (NOTE: Offeror can provide CPARS with proposal; however, the questionnaire has more detailed questions.)

D. Provide detailed description of the work performed under the contract and describe why you believe the work is VERY REVELANT, RELEVANT, SOMEWHAT RELEVANT, or NOT RELEVANT.

Very Relevant
Present/past performance effort involved essentially the same scope and magnitude of effort and complexities this solicitation requires.
Relevant
Present/past performance effort involved similar scope and magnitude of effort and complexities this solicitation requires.
Somewhat Relevant
Present/past performance effort involved some of the scope and magnitude of effort and complexities this solicitation requires.
Not Relevant
Present/past performance effort involved little or none of the scope and magnitude of effort and complexities this solicitation requires.

Relevance detailed description of project to include work by subcontractors:

Point of Contact of Reference on project (who you are sending questionnaire/survey to):

Name: ________________________ Title: ________________________ Agency: ________________________ Email: ________________________ Phone: ________________________ POTENTIAL OFFERORS: IT IS YOUR RESPONSIBILITY TO FOLLOW-UP WITH YOUR REFERENCES IN SUBMITTING QUESTIONNAIRES PRIOR TO THE CLOSE OF THE SOLICITATION.

PART 2. NOT RELATED TO PART 1: Additional offeror information required, but not project specific. THIS INFORMATION NEED ONLY BE PROVIDED ONCE IN YOUR SUBMISSION PACKAGE.

Offeror representative providing the below information:_______________________

1. Provide information regarding the assessment of liquidated damages on any contracts within the last five years. (Frequency, circumstances, severity of problem, etc.)

2. Offerors are strongly encouraged to include with their proposals information on problems encountered on any relevant projects and the specific corrective actions taken to remedy the problems. Furthermore, please provide explanation of any marginal ratings in CPARS if applicable:

3. Other Past Performance Considerations. Information provided shall be limited to the period starting five years prior to the solicitation release date and may include the following:

a. Professional/Industry awards (Identify award type, date of award and copy of certificate if applicable), Letters of appreciation, recognition or commendations

b. Discuss unique skills and accomplishments (Explain unique skills and/or accomplishments and provide supporting information for verification).

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

· Descriptions must address the following:

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

· Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on this project.

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