EXHIBIT E - Past Performance Questionnaire 36C24420R0148.pdf
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- Attached to
- Z1DA--646-19-103 UD Reno 6E 48 Hour Observation
- Solicitation number
- 36C24423R0148
About this file
This document is a past performance questionnaire for a contractor bidding on Department of Veterans Affairs solicitation number 36C24423R0148 for renovation services at the UD Reno 6E 48 Hour Observation unit. The contractor must provide the questionnaire to past performance references who will evaluate performance across criteria such as quality, timeliness, business practices, compliance, safety, and overall customer satisfaction. References are asked to return the completed questionnaire to the contracting officer by August 22, 2023. The solicitation seeks renovation services from prime contractors and subcontractors to meet the Veterans Health Administration's requirements.
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Text version
Department of Veterans Affairs
Network Contracting Office 4
1010 Delafield Road
Pittsburgh, PA 15215
1 | P a g e
Past Performance Questionnaire for: 36C24423R0148 UD Reno 6E 48 Hour
Observation
INSTRUCTIONS TO OFFEROR
Complete the CONTRACTOR INFORMATION section, below (type answers into light blue shaded boxes). Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions, below.
Company Name Street
Address
Point of Contact
(POC)
City
POC Phone Number State
Reference Project
Title Zip Code
Contract Period of
Performance (start to finish):
Contract Number
Contract
Dollar
Value
Description of Work
Role of Contractor on This Project
(check appropriate box)
Prime Contractor Sub-contractor Key Personnel
INSTRUCTIONS TO REFERENCE CONTACT
The contractor named above is submitting a proposal for a United States Department of Veterans Affairs contract, and has sent this form to you as a past performance reference contact. Please complete the following pages in full (all areas shaded in light yellow, below). Once completed, please send the form to the Contracting Officer email directly to:
John.Mignogna@va.gov
Please return the completed form ASAP, but no later than 2:00 pm local time, August 22 2023 If you have any questions, please contact the Contracting Officer: Elijah.mcintosh@va.gov.
RESPONDENT INFORMATION [completed by Reference Contact]
Company Name Street Address
POC Name City
Phone Number State
Email Zip Code
PERFORMANCE INFORMATION: Choose the number on the scale of 0 (Neutral) to 5 (Exceptional) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE AN
EXPLANATION FOR THE OVERALL RATING in the Remarks section, below.
0 1 2 3 4 5
NEUTRAL UNACCEPTABLE MARGINAL ACCEPTABLE VERY GOOD OUTSTANDING
No record of past performance, or not applicable or the record is inconclusive.
Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.
Performance did not meet some contractual requirements.
There were problems, some of a serious nature, for which corrective action was only marginally effective.
Performance met most contractual requirements.
There were some minor problems and corrective actions taken by the contractor were satisfactory.
Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems, which the contractor resolved in a timely, effective manner.
Performance exceeded all contract requirements. There were no problems.
The Contractor … 0 1 2 3 4 5
QUALITY – MANAGEMENT & WORKMANSHIP
1.
Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.
2.
Demonstrated ability to hire, maintain, and replace, if necessary, qualified construction personnel during the contract period.
3.
Provided and followed approved quality control plan and/or inspection procedures to meet contract requirements.
4.
Corrected deficiencies in timely manner and pursuant to their quality control procedures.
5.
Submittals clearly identified the proposed item IAW the specifications and drawings.
6. Suggested alternative approaches to problems.
TIMELINESS AND ADHERENCE TO SCHEDULE
7.
Contractor provided timely notices of possible delays/schedule revisions.
REMARKS:
8.
Timeliness in submitting submittals and reports and responding to agency inquiries, RFP's, etc.
9. Developed realistic and met approved progress schedules.
BUSINESS PRACTICES/CUSTOMER RELATIONSHIP AND ABILITY TO PERFORM
10.
Displayed initiative to solve problems.
11.
How well did the contractor work independent of Government guidance, oversight and assistance?
12.
Subcontractors / tradesmen were adequately managed and coordinated. Explain any subcontracting issues (positive or negative) that impacted the performance of your contract(s).
13.
For contract changes, contractor provided timely and realistic change order proposals.
COMPLIANCE & SAFETY
14.
Reports (i.e., daily, test, logs) / records were submitted completely and accurately satisfy the requirement.
15.
Applicable to Federal Contracts –Contractor complied with applicable
Federal Laws and Regulations such as Construction Wage Rate
Requirements – timely payrolls and compliance; Drug-Free
Workplace; Environmental Regulations and Use of Recovered
Materials; Executive Order 13101 Greening the Government.
16.
Contractor’s safety program was in compliance with federal regulations. Contractor implemented and followed their safety plan and ran a “safe jobsite”.
INFECTION CONTROL
17.
Contractor had an Infection Control Process in place and complied with agency Infection Control Requirements.
OVERALL CUSTOMER SATISFACTION
18. Demonstrated reasonableness in modifications cost proposal.
19.
Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
YES NO
20.
Would you award another contract to this contractor? If not, please explain in “remarks.”
YES NO
OVERALL PERFORMANCE RATING:
REMARKS (Please use as much space as is needed – the box will expand as you type).
I hereby certify that the information that I have reported above is accurate to the best of my knowledge.
Printed Name
E-mail address
Business Title Signature Date
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