EXHIBIT E - Past Performance Questionnaire.docx

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Attached to
Y1DA--Renovate Building 22 Construction | Project #595-15-201
Solicitation number
36C24421R0001
Issued by

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This document contains a past performance questionnaire and a notice of a federal contract opportunity to renovate Building 22 at the Lebanon VA Medical Center in Pennsylvania. The past performance questionnaire is a template for contractors to send to references to evaluate their performance on prior federal contracts.

The related federal contract opportunity is to award a firm-fixed price contract for construction services to renovate an education center and support spaces on the second floor of Building 22. The scope of work includes demolition, construction of floors, ceilings, mechanical and electrical systems. The period of performance is 545 calendar days. The solicitation will be issued on July 6, 2020 as a 100% service-disabled veteran-owned small business set-aside with a NAICS code of 236220 and size standard of $39.5 million. The estimated value is between $2-5 million. Questions are due by August 31, 2020 to the Contracting Officer with responses posted online. A pre-bid site visit will be scheduled after solicitation posting. Offerors must be registered in SAM and verified in CVE databases to be eligible for award.

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Department of Veterans Affairs

Network Contracting Office 4 1010 Delafield Road Pittsburgh, PA 15215

Past Performance Questionnaire for: 36C24421R0001 Renovate Building #22 Construction

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):

Email

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 via postal mail or email directly to:

Department of Veterans Affairs Lebanon VA Medical Center ATTN: Melvin Moore / 36C24421R0001 1700 South Lincoln Ave Lebanon, PA 17042 Email address: melvin.moore2@va.gov

Please return the completed form ASAP, but no later than 1:00 pm local time, August 31, 2020.

If you have any questions, please contact the Contracting Officer: melvin.moore2@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.
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2.
Demonstrated ability to hire, maintain, and replace, if necessary, qualified construction personnel during the contract period.
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3.
Provided and followed approved quality control plan and/or inspection procedures to meet contract requirements.
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4.
Corrected deficiencies in timely manner and pursuant to their quality control procedures.
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5.
Submittals clearly identified the proposed item IAW the specifications and drawings.
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6.
Suggested alternative approaches to problems.
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TIMELINESS AND ADHERENCE TO SCHEDULE

0
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5
7.
Contractor provided timely notices of possible delays/schedule revisions.

REMARKS:

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8.
Timeliness in submitting submittals and reports and responding to agency inquiries, RFP's, etc.
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9.
Developed realistic and met approved progress schedules.
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BUSINESS PRACTICES/CUSTOMER RELATIONSHIP AND ABILITY TO PERFORM

10.
Displayed initiative to solve problems.
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11.
How well did the contractor work independent of Government guidance, oversight and assistance?
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12.
Subcontractors / tradesmen were adequately managed and coordinated. Explain any subcontracting issues (positive or negative) that impacted the performance of your contract(s).
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13.
For contract changes, contractor provided timely and realistic change order proposals.
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COMPLIANCE & SAFETY

0
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5
14.
Reports (i.e., daily, test, logs) / records were submitted completely and accurately satisfy the requirement.
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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.
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16.
Contractor’s safety program was in compliance with federal regulations. Contractor implemented and followed their safety plan and ran a “safe jobsite”.
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INFECTION CONTROL

17.
Contractor had an Infection Control Process in place and complied with agency Infection Control Requirements.
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OVERALL CUSTOMER SATISFACTION

18.
Demonstrated reasonableness in modifications cost proposal.
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19.
Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”
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YES
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NO
20.
Would you award another contract to this contractor? If not, please explain in “remarks.”
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YES
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NO
OVERALL PERFORMANCE RATING:
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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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