SECTION IV Attachment IV. 2--- Past Performance Exhibit A and B.doc

SECTION IV ---- ATTACHMENT IV. 2 PAST PERFORMANCE EXHIBIT A AND B

SOURCE SELECTION INFORMATION

(SEE FAR 2.101 & 3.104)

RFP #HSBP1010R0054

SOURCE SELECTION PLAN (SEE FAR 3.104)

Procurement Sensitive

RFP #HSBP1010R0054

EXHIBIT “A” (Page 1 of 2) Project # ______

PROJECT DATA SHEET

Identify the offeror’s Past Performance and Specialized Experience with respect to this RFP. Include government or commercial projects.

Contract/Project Number/Task Order Number/Contract Title/Location (Government or Commercial): _________________________________________________________________

Actual Completion Date or Projected Completion Date (if at least 80% physically complete) (Date shall include Month and Year): __________________________

Were you the Prime Contractor ________ or Sub Contractor ________

Award Date (Mo & Yr) __________ Original Completion Date (Mo & Yr) ______________

Award Amount: $________________ Final Contract Price:____________________

Firm that accomplished this work:

Firm’s Name: _______________________

Point of Contact (POC): ________________

Address: ___________________________

City/State ___________________________

Phone Number: _______________________

Fax Number: _________________________

E-mail Address: ______________________

If subcontractor, list prime contractor

Firm’s Name: _______________________

Point of Contact (POC): ________________

Address: ___________________________

City/State ___________________________

Phone Number: _______________________

Fax Number: _________________________

E-mail Address: ______________________

Customer Name: ______________________

Point of Contact #1: ____________________

Phone Number: _______________________

Fax Number: _________________________

E-mail Address: _______________________ Point of Contact #2: __________________

Phone Number: _____________________

Fax Number: _______________________

E-mail Address: _____________________

Project description, relevancy of work performed by your firm and how it demonstrates the quality of work as it relates to this RFP. Include type of contract (e.g., fixed price, cost, IDIQ, MAC, etc.) Identify any Value Engineering proposals submitted and approved.

EXHIBIT “A” (Page 2 of 2)

PROJECT DATA SHEET

Continuation sheet

Contract/Project Number/Contract Title/Location:_____________________________

Firm’s Name: _____________________________

Project Description Continued:

Problems encountered and corrective action taken:

Industry Awards/Special Recognition Received for project listed. (Awards, certificates and letters of recommendation should be submitted in Volume 1 under Tab C and will not count in the page limitation for Exhibit A).

EXHIBIT "B" (Page 1 of 4) ) Project # ______

PAST PERFORMANCE QUESTIONNAIRE

The contractor listed below is being considered in a Source Selection by U.S. Customs and Border Protection, Washington, D.C. It would be appreciated if you would provide us with comments regarding the contractor's past performance. Your comments are considered Source Selection Sensitive, therefore, you are advised that the Federal Acquisition Regulation (15.506) prohibits the release of the names of individuals providing reference information about an offeror's past performance. In order to maintain the integrity of the source selection process, it is requested that you do not divulge the name of the contractor nor discuss your comments on this questionnaire with any other individuals. Upon completion of the questionnaire, please place it in a sealed envelope with your company's or agency’s return address and forward to the offeror shown below no later than _________________ (Offeror to enter date).

Past Project Information:

1. Offeror (firm submitting this request): _________________________________________

2. Address: _____________________________________ Phone Number:_____________

3. Firm being evaluated (offeror or team subcontractor):_____________________________

4. Contract Number/Project Title being evaluated: _________________________________

Evaluator: (the following information will assist in the analysis of the data. Information will be kept confidential)

1. Name of Evaluator: ________________________________________________

2. Firm/Agency Name Address:

3. Phone Number: __________________

4. Position held or function in relation to project: _____________________________

Rating: Please evaluate the contractor's performance using the following ratings only:

(Do not rate on a "+" or "-" scale. Please use only the ratings provided above, without variation)

Please rate and provide any supporting information for the following:

1. The relationship between the contractor and owner's contract team and project manager.

______________________________________________________ Rating _______

EXHIBIT "B" (Page 2 of 4) PAST PERFORMANCE QUESTIONNAIRE (continuation sheet)

2. The contractor's on-site management and coordination of subcontractors.

__________________________________________________________________________________________________________________________Rating _______

3. The contractor's overall corporate management, integrity, reasonableness and cooperative conduct: __________________________________________________________________________________________________________________________Rating _______

4. The contractor's performance on delivery of quality work:

__________________________________________________________________________________________________________________________Rating _______

5. The contractor's quality control (CQC): __________________________________________________________________________________________________________________________Rating _______

6. The contractor's ability to meet the performance schedule:

__________________________________________________________________________________________________________________________Rating _______

7. The contractor's ability/actions to improve schedule problems, if applicable:

__________________________________________________________________________________________________________________________Rating _______

EXHIBIT "B" (Page 3 of 4)

PAST PERFORMANCE QUESTIONNAIRE(continuation sheet)

8. The contractor's ability to control costs and provide the required work at a reasonable total price:

____________________________________________________________________________________________________________________________Rating _______

9. The contractor's compliance with labor standards, if applicable:

____________________________________________________________________________________________________________________________Rating _______

10. The contractor's compliance with safety standards and/or number of safety related incidents:

____________________________________________________________________________________________________________________________Rating _______

11. Has the contractor been issued any cure notices, show cause letters, letters of reprimand, suspension of payments, termination? If yes, please explain:

________________________________________________________________________________________________________________________Yes______No_______

12. Would you award another contract to this contractor? If no, please state reasons for not recommending this contractor for additional work:

________________________________________________________________________________________________________________________Yes ______No______

13. Was the customer satisfied with the end product?

________________________________________________________________________________________________________________________Yes ______No______

EXHIBIT "B" (Page 4 of 4)

PAST PERFORMANCE QUESTIONNAIRE (continuation sheet)

14. Has the contractor been provided an opportunity to discuss any negative interim or final performance ratings? If so, what were the results?

______________________________________________________________________________________________________________________________________________________________________________________________Yes _____No______

OVERALL RATING: ______________________

Please provide any additional applicable comments: