Exhibit M Past Performance Questionnaire.pdf

DEPARTMENT OF VETERAN AFFAIRS

MOUNT PLEASANT AS BUILT CLINIC/LEASE

NCO 7

SOURCE SELECTION SENSITIVE FAR 2.101 and 3.104

PAST PERFORMANCE QUESTIONNAIRE

Introduction:

This questionnaire is designed to collect past performance information on Offerors (Landlord/ Lessors) competing for award of this lease. Please note the questionnaire is not based on the past performance of brokers facilitating the procurement, but rather for the prospective awardees that will be responsible for the lease under consideration.

Instructions for the Offeror:

Please complete Section 1 on Page 2. If the “no relevant past performance” box is checked, then do not proceed in filling out the form and email (preferred) or mail form to the Contract Specialists’ contact information below.

For the Offeror to have relevant past performance, at least one of the following must be true:

• The Offeror recently leased a space for 5,000 RSF or more within the last 3 years

• The Offeror recently leased medical office or general office space within the last 3 years

• The Offeror recently leased space to any Government entity within the last 3 years

If the Offeror has relevant past performance, the Offeror must forward a copy of this questionnaire to 3 tenant references that fulfill at least one of the criteria listed above. The Offeror must instruct the References to complete pages 3‐5 of this form. Once the respondents have completed the form, they must email the form to the Contract Specialist listed below.

Attn: Michael Elisha James, Leasing Contracting Officer (LCO)

Department of Veteran Affairs, NCO 7

Subj: Past Performance Questionnaire RLP# 36C24724R0084

Email: Michael.james6@va.gov

Cell: 813‐447‐0780

For assistance with this form please contact the LCO listed above. Hand written responses will be accepted. Responses will be treated as confidential and procurement sensitive.

SECTION 1 – Lessor (to be evaluated) Information:

Name or Company:

Phone Number:

Email:

□ Only check this box if the Offeror has no relevant past performance

NOTE:

IF THE ABOVE STATEMENT IS CHECKED, PLEASE DO NOT PROCEED ANY FURTHER

AND EMAIL THE FORM TO THE LCO LISTED ON PAGE 1.

Instructions for the Respondent:

Please complete Sections 2 and 3 on the following page to the best of your knowledge using the appropriate ratings below. When completed, please email (preferred) or mail the form to the Contract Specialists’ contact information below.

Department of Veteran Affairs, NCO 7

Attn: Michael Elisha James, LCO

Subj: Past Performance Questionnaire RLP# 36C24724R0084

Email: Michael.james6@va.gov

Cell: 813‐447‐0780

For assistance with this form please contact the LCO listed above. Hand written responses will be accepted. Responses will be treated as confidential and procurement sensitive.

Explanation of Codes:

EXCEPTIONAL – Lessor significantly exceeded expectations

GOOD – Lessor met and to some extent exceeded expectations

SATISFACTORY – Lessor met expectations

MARGINAL – Lessor did not fully meet expectations

UNSATSIFACTORY – Lessor failed to meet expectations

NOT APPLICABLE – Unable to provide a score

SECTION 2 ‐ Respondent Information:

Name: Title:

Phone Number: Email:

Lease Square Footage: Organization/ Company:

Use of Space (Check One): □ Office □ Medical Office □ Other

SECTION 3 ‐ Past Performance Questions:

Build Out / Cost Control

1. How satisfied were you with the Lessor’s commitment to your budget?

□ Excellent □ Good □ Satisfactory □ Marginal □ Unsatisfactory □ Not applicable

What could have improved your score:

2. How satisfied were you with the Lessors handling and pricing of change orders?

□ Excellent □ Good □ Satisfactory □ Marginal □ Unsatisfactory □ Not applicable

What could have improved your score:

3. How satisfied were you with the Lessors ability to stay on schedule?

□ Excellent □ Good □ Satisfactory □ Marginal □ Unsatisfactory □ Not applicable

What could have improved your score:

Lease Administration Performance

4. In accordance with your lease, how satisfied were you regarding the Lessor’s responsiveness to any maintenance issues?

□ Excellent □ Good □ Satisfactory □ Marginal □ Unsatisfactory □ Not applicable

What could have improved your score:

5. In accordance with your lease, how satisfied were you regarding the Lessor’s responsiveness to any safety issues?

□ Excellent □ Good □ Satisfactory □ Marginal □ Unsatisfactory □ Not applicable

What could have improved your score:

6. In accordance with your lease, how satisfied were you regarding the Lessor’s responsiveness to any security issues?

□ Excellent □ Good □ Satisfactory □ Marginal □ Unsatisfactory □ Not applicable

What could have improved your score:

7. In accordance with your lease, how satisfied were you regarding the Lessor’s cleanliness of the building premises and common areas?

□ Excellent □ Good □ Satisfactory □ Marginal □ Unsatisfactory □ Not applicable

What could have improved your score:

8. In accordance with your lease, how satisfied were you regarding the Lessor’s overall performance?

□ Excellent □ Good □ Satisfactory □ Marginal □ Unsatisfactory □ Not applicable

What could have improved your score:

9. Would you sign a lease with the Lessor again?

Excellent (Yes) □ Unsatisfactory (No) □

If no, why not: