J-4b Past Performance Reference Form - HCF Roofing - Draft 10-31-22.doc

PAST PROJECT PERFORMANCE REFERENCE FORM

For FAA Construction Services Solicitation RFO 697DCK-23-R-00XXX

1. Contractor Name:

2. Contractor Location (City, State):

3. Title of Construction Project:

4. Location of Construction Project

(City, State):

5. This Contractor was:

___ Prime Contractor

___ A Sub-Contractor

Prospective Contractor or Subcontractor, please fill out the above information and provide the following two items to a POC of the Owner Entity who is familiar with your work on this past project and can fill out this performance survey form and respond:

(1) A copy of the Past Project Record for this project that is being submitted for this Solicitation.

(2) This Past Project Performance Reference Form.

Survey respondent, please return the completed survey by e-mail to:

Darren Odegard, FAA Contracting Office

206-231-3002, darren.odegard.faa.gov

Owner’s POC’s Evaluation and Commentary regarding

Contractor’s Performance on This Project

1 - Unsatisfactory, 2 - Marginal, 3 - Satisfactory, 4 - Good, 5 - Outstanding, N/A - Not Applicable 1.

Did the Contractor provide adequate resources in timely fashion to meet the requirements and complete the work?

1( 2( 3( 4( 5( N/A( 2.

To what extent did the Contractor respond positively and promptly to technical direction, information requests, issues or problems needing correction, etc., during the course of the Work?

1( 2( 3( 4( 5( N/A( 3.

How reliably did the Contractor follow through on commitments?

1( 2( 3( 4( 5( N/A( 4.

Did the Contractor’s work coordinate with, accommodate, and not disrupt the ongoing operation of the facility during construction?

1( 2( 3( 4( 5( N/A( 5.

Did the Contractor comply with construction safety requirements?

6.

Were any requests for change order Contract amount increases justified, reasonably costed, and, if necessary, negotiated with prompt, acceptable resolution?

6.

Were the Contractor’s project management, site supervision and work crews capable, experienced and consistence throughout the course of the project? Was there no turnover or low turnover in the Contractor’s project personnel?

7.

What was your level of satisfaction with the Contractor’s project management?

1( 2( 3( 4( 5( N/A( 8.

What was your level of satisfaction with the Contractor’s on-site supervision?

1( 2( 3( 4( 5( N/A( 9.

What was the quality of the project construction Work?

1( 2( 3( 4( 5( N/A( 10.

Was this Contractor professional, positive and easy to work with?

1( 2( 3( 4( 5( N/A( 11.

Extent you would recommend this Contractor for a similar construction project?

1( 2( 3( 4( 5( N/A( To the extent you know, is the project information on the Contractor’s Past Project Report accurate?

___ Yes ___ No ___ I have insufficient knowledge of the project details to know.

If no, do you have any more accurate information:

Comments on the Contractor’s Performance and their Work:

Responding POC’s Name: ______________________________________________ Project Owner Entity and responding POC’s work role within the Owner Entity:

Responding POC’s work role on the project:

Responding POC’s Contact Phone Number(s) and E-mail:

Can the FAA contact you by telephone with any additional reference questions?

____ Yes. ____ No.

Signature: _____________________________________ Date: _____________________________________ HCF Roof Solicitation / Past Performance Reference Form / DRAFT 10-31- 2022 / Page 1 of 3