EXHIBITS A B-Past Performance Project Data Questionnaire.docx

EXHIBIT “A” – OFFEROR

PAST PERFORMANCE PROJECT DATA SHEET

RFP # HQ0034-12-R-0004

The purpose of this form is to provide supporting project information for Past Performance. This form is to be completed by the Offeror.

1. Project No. (check one): |_| - 1 |_| - 2 |_| - 3

2. Contract Number, Delivery/Task Order Number, Project Number, Title, and Location:

3. Award Date (mm/dd/yy):

Completion Date (mm/dd/yy):

Is project at least 80% complete: |_| Yes |_| No

4. Award Amount:

Final Contract Price (including all options):

Is this the |_| total project or |_|subcontract price

5. Type of work: |_| New Construction |_| Renovation |_| Repair |_| Alteration

6. Type of Contract:

|_| Design-Build |_| Design-Bid-Build |_| Other (explain):

7. Firm Who Performed the Work: (check one)

|_| Contractor |_| Sub Contractor

Firm’s Name:

If your firm was a subcontractor on this project, identify the prime:

If a Design-Build Project, identify the Lead Design Firm:

8. Customer/Owner Information:

Customer Name:

Point of Contact:

Phone Number:

FAX Number:

E-mail address:

9. If this project was performed by key personnel, a subsidiary, satellite office, or parent company, explain how this office/person will participate in this contract.

10. Provide a detailed description of the project:

11. Provide a detailed description of what work your firm self performed on the project:

12. Was the project completed ahead of schedule? If so, how many calendar days ahead?

13. Was the project completed without safety related incidents? If not, provide a description of the incidents and the resultant time lost. Also include what corrective actions, if any, were taken.

14. Provide the final performance rating received for this project or if unfinished, but 80% or more complete, any interim rating received. If the rating received was less than Satisfactory, then provide a brief description of the problem(s) resulting in this evaluation and what corrective action, if any, was taken.

15. Attach any legible copies or photographs of industry awards/special recognitions, etc., received for this project.

Form may be expanded

EXHIBIT “B” PAST PERFORMANCE QUESTIONNAIRE

RFP # HQ0034-12-R-0004

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and email to francisco.fernandez.ctr@whs.mil or by postal mail to:

WHS/AD

Attn: Francisco “Frank” Fernandez 2521 S. Clark, Suite 3000 Arlington, VA 22202 Desired Response Date:

17 January 2012

When complete, the information on this form is SOURCE SELECTION INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

3. CONTRACT/SUBCONTRACT INITIATION DATE:

4. COMPLETION DATE:

1. B. NAME OF OFFERING TEAM:

5. CONTRACT/SUBCONTRACT VALUE (with options):

6. PROJECT TITLE, LOCATION, AND DESCRIPTION (INCLUDING TOTAL CONSTRUCTION VALUE):

Please add a continuation page if additional space is necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

7. EVALUATION: a. EVALUATOR'S NAME, POSITION ( Project Manager/ COR/ Other) AND ORGANIZATION:

b. EVALUATOR'S PHONE NUMBER:

c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

8. Please circle the response code for each topic (A – G) that best reflects your experience with this contractor.

EX = Exceptional VG = Very Good S = Satisfactory MG = Marginal US = Unsatisfactory N/O = Not Observed

A. Quality of Products and Services - Assess the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards).

EX VG S MG US N/O

B. Performance – Assess the contractor’s performance as the General Contractor or Architect/Engineer (as appropriate) for the project.

EX VG S MG US N/O

C. Schedule – Assess the timeliness of contractor against the schedule of activities.

EX VG S MG US N/O

D. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract.

EX VG S MG US N/O

E. Cost Control – Assess the contractor’s ability to manage the contract budget and control costs.

EX VG S MG US N/O

F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”.

EX VG S MG US N/O

G. Overall Assessment

EX VG S MG US N/O