Attachments_A _B _C.pdf

ATTACHMENT A: OFFEROR’S SITE PREP EXPERIENCE FORM SOLICITATON: HSFE10-14-R-5001

PROJECT No. (Check one): - 1 - 2 - 3

Name of Offeror: _________________________________________________________________

E-mail Address: __________________________________________________________________

Telephone Number: ______________________________________________________________

Project Title: ____________________________________________________________________

Contract Number: _______________________________________________________________

Contract Amount (U.S. Dollar Amount): _____________________________________________

Contract Completion Date: ________________________________________________________

Contract Duration (Period of Performance):__________________________________________

Location of Project: ______________________________________________________________

Customer Name: ________________________________________________________________

Point of Contact with Email Address: _______________________________________________

Contracting Office: ______________________________________________________________

Contracting Officer’s Name with Email Address: ______________________________________

Contracting Officer Representative: _________________________________________________

Description of the Project’s Scope, Magnitude and Relevance:

Details of your company’s role and activities during construction of this project: (describe your role in this project. Include whether your firm participated as a prime or as a subcontractor.

ATTACHMENT B – OFFEROR PAST PERFORMANCE PROJECT SHEET SOLICITATION: HSFE10-

14-R-5001

The purpose of this form is to provide supporting project information for Past Performance of the three projects provided for Factor 1, Experience. This form shall be completed by the Offeror. Only projects that fit within the parameters for this factor as defined in the solicitation will be evaluated. All other projects will be removed and discarded prior to evaluation.

1. Project No. (Check applicable project from Attachment A): - 1 - 2 - 3

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

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

4. Award Amount:

5. Completion Date (mm/dd/yy):

6. Final Contract Price (including all options):

7. At least 80% complete: Yes No

8. Customer/Owner Information:

Name/Point of Contact: Contact Number: FAX Number:

E-mail address:

9. Who were the key personnel on this project?

10. Provide a description of the project:

11 Discuss any problems encountered and corrective action taken:

12. Provide a self-assessment of your firm’s overall performance on this project:

13. Attach any legible copies or photographs of industry awards/special recognitions, etc., received for this project (maximum of one page):

ATTACHMENT C: PAST PERFORMANCE REFERENCE QUESTIONNAIRE Page 1 of 2

PROJECT No. (Check applicable project from Attachment A): - 1 - 2 - 3

The Department of Homeland Security Federal Emergency Management Agency is considering the Offeror listed below. Your comments would be appreciated regarding this firm’s past performance. Your comments are considered Source Selection Sensitive. You are advised that Federal Acquisition Regulation Section 15.506 prohibits the release of the names of individuals providing reference information about an Offeror’s past performance. The solicitation requires the Past Performance Evaluation Questionnaire be sent directly to the US Government. Please email this completed form to Daisy.Joseph@fema.dhs.gov by close of business 17 April 2014.

In order to maintain the integrity of the source selection process, it is respectfully requested that you do not divulge the name of the Offeror nor discuss your comments on this questionnaire with any other individuals.

Past Performance Information:

Name of Offeror being evaluated:

Contract Number/Delivery or Task Order Number, Title, & Location:

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

Name of Evaluator:

Address & Phone Number:

Position held or function in relation to project:

Please evaluate the performance in the areas highlighted in paragraphs a. thru f. on Page 2 using only the following ratings: Acceptable / Unacceptable

Not Applicable: Unable to provide a rating. Performance in this area not applicable to the effort assessed.

SOLICITATION: HSFE10-14-R-5001

ATTACHMENT C: PAST PERFORMANCE REFERENCE QUESTIONNAIRE Page 2 of 2

a. How well did the contractor provide Quality of Product and Services? The Government will assess the quality of the actual construction undertaken and the standards of workmanship exhibited by the Offeror’s team, and the Offeror’s ability to execute a quality control program.

� Acceptable � Unacceptable

b. How well did the contractor provide Timeliness of Performance? The Government will evaluate all information available with respect to the Offeror’s ability to develop a project schedule, execute according to that schedule, and complete projects within the scheduled completion times.

� Acceptable � Unacceptable

c. How well did the contractor perform in a Cooperative Manner? The Government will evaluate whether the Offeror has cooperated in achieving the customer’s goals, particularly with respect to resolution of construction problems and minimizing cost and time impacts.

� Acceptable � Unacceptable

d. How well did the contractor provide Customer Satisfaction? The Government will evaluate whether prior customers are satisfied with the Offeror’s completed work, i.e., would prior customers choose to do business with the Offeror again if given the choice.

� Acceptable � Unacceptable

e. How well did the contractor perform in respect to Safety? The Government will evaluate whether the Offeror has completed projects in a safe manner in compliance with all appropriate safety standards.

� Acceptable � Unacceptable

f. How would you rate your Overall Satisfaction with this contractor? The Government will evaluate any other information that would have a bearing on how well the contractor satisfies its customers, complies with contract requirements, or delivers a quality product in a timely manner.

� Acceptable � Unacceptable

REMARKS: (Please provide any additional comments on Acceptable or Unacceptable ratings):

SOLICITATION: HSFE10-14-R-5001