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Please provide any additional comments that may help determine the business and financial reputation and integrity of the prospective contractor on a separate sheet.

FINANCIAL QUESTIONNAIRE

N62473-17-R-1413

(To be completed by Financial Institution and submitted by Offeror)

NAVFAC Southwest, San Diego, California is currently considering award of a Navy contract to this firm. Prior to award, the Navy requests the financial information listed below with regard to this firm. In order to be responsive to the Navy’s needs, it is requested that you complete this financial questionnaire with regard to this firm. Upon completion of the questionnaire it is requested that you place the completed questionnaire in a sealed envelope showing the return address of the financial institution and forward it to the Offeror shown below. The requested information must be received by the contractor no later than _______________________

Prospective Contractor for which information is being requested:

Name:

Address:

Phone Number:

Point of Contact:

Signature of Prospective Contractor or Contractor Representative Requesting Financial Information

Name of Financial Institution:

Address:

Phone Number:

Account Number:

Type of Account:

Average Balance Figure :

Does the Contractor have a line of credit? Yes No

What is the limitation?

Remaining Balance:

What is the Contractor’s relationship with the bank?

Outstanding Satisfactory Other (explain):

How long has the Contractor been a client?

Name and Title of person providing the above information:

Signature of person providing the above information

EXHIBIT “A”

OFFEROR TEAM COMPOSITION AND MANAGEMENT

N62473-17-R-1413 Use this form to provide information regarding the primary members, composition, and management of the proposed design-build team for Factor 1, Technical Approach. If Offeror is a partnership (e.g., JV, Mentor-Protégé), list each partner as a separate team member. If the experience of an entity is being claimed in Factor 2, that entity must be identified and described on this Exhibit. Modify form as necessary to include all primary construction and primary design team members. Do not include information for individuals. Do not exceed two (2) pages.

Team Member 1 Name: Location: DUNS:

Contractual relationship to the team:

Describe team member role, responsibilities, and meaningful involvement in performance of the contract:

If located outside of California, explain how entity will have meaningful involvement from a remote location.

Team Member 2 Name: Location: DUNS:

Describe team member role, responsibilities, and meaningful involvement in performance of the contract:

If located outside of California, explain how entity will have meaningful involvement from a remote location.

Team Member 3 Name: Location: DUNS:

Describe team member role, responsibilities, and meaningful involvement in performance of the contract:

If located outside of California, explain how entity will have meaningful involvement from a remote location.

Team Member 4 Name: Location: DUNS:

Describe team member role, responsibilities, and meaningful involvement in performance of the contract:

If located outside of California, explain how entity will have meaningful involvement from a remote location.

Team Member 5 Name: Location: DUNS:

Describe team member role, responsibilities, and meaningful involvement in performance of the contract:

If located outside of California, explain how entity will have meaningful involvement from a remote location.

Discuss the rationale for proposing this team arrangement:

Note: Form may be expanded.

EXHIBIT “B”

CONSTRUCTION EXPERIENCE PROJECT DATA SHEET – DESIGN FIRM

N62473-17-R-1413 This form is to be completed by the Design Firm. Submit (one per project) in order to provide supporting project information for Factor 2, Experience. Only projects that are within the project description parameters of the solicitation will be considered relevant. Submit up to 5 projects. All other projects will not be considered. Do not exceed two (2) pages per project.

Project No. (check one): - 1 - 2 - 3 - 4 - 5

Design Firm:

1. Design Firm Name:

Design Firm Address:

Firm who performed the work: (this is Team Member # from Exhibit “A”)

Performed this work as: Lead Design Firm Sub-Consultant

Other (explain):

If sub-consultant, name of Lead Design Firm:

Phone #:

If the firm who performed the work differs from the Design Firm named above, identify the firm’s relationship to the named Design Firm.

Parent Company Subsidiary Satellite Office

Predecessor Company Affiliate Other:

Explain the relationship and how this firm will have meaningful involvement in the performance of the contract:

Note: For purposes of the evaluation, the address above must match the address provided on the proposal Cover Letter and the submitted past performance evaluation form (PPQ/ACASS) for this project; otherwise provide a complete explanation above.

Design Contract:

2. Contract/Project No.: Delivery/Task Order Number:

Title:

Location:

3. Award Date (mm/dd/yy): Final Construction Cost: $

Design Completion Date (mm/dd/yy):

(excluding any construction phase support services such as PCAS)

4. Type of Contract: Design-Build (designed and constructed under a single contract)

(check one) Design-Bid-Build (bid from fully-designed plans and specifications)

Other (explain):

If D-B, construction contractor firm was:

Firm is not a member of the proposed team for this MACC Firm is Team Member # from Exhibit “A”

Customer:

5. Name:

Point of Contact Name/Title:

POC Phone Number: POC Email Address:

Project Description:

This project was primarily New construction Renovation (see definition; check one box only).

6. Provide a detailed description of the project and its relevancy to the intended work of this MACC. Include the features of work that demonstrate the project was primarily new construction or primarily renovation.

7. Provide a description of what work your design firm self-performed on this project.

EXHIBIT “B”

CONSTRUCTION EXPERIENCE PROJECT DATA SHEET – OFFEROR

N62473-17-R-1413 This form is to be completed by the Offeror. Submit (one per project) in order to provide supporting project information for Factor 2, Experience. Only projects that are within the project description parameters of the solicitation will be considered relevant. Submit up to 5 projects. All other projects will not be considered. Do not exceed two (2) pages per project.

Project No. (check one): - 1 - 2 - 3 - 4 - 5

Contractor:

1. Offeror Name:

Firm who performed the work: (this is Team Member # from Exhibit “A”)

Performed this work as: Prime Contractor Subcontractor

If subcontractor, name of prime: POC:

If JV or other partner, name(s) of the other partner(s):

Phone

If the entity who performed the work of this project differs from the Offeror proposing on this contract, identify the relationship to the Offeror:

Joint Venture partner Mentor-Protégé partner Parent company Subsidiary

Satellite office Predecessor company Affiliate Other

Explain the relationship:

Note: For the purposes of the evaluation, the firm who performed the work of this project must be named on Exhibit “A” and fully described as a team member who will have meaningful involvement in performance of the relevant work of this contract; the address provided in Block 14 of the SF 1442 must match that of the proposal Cover Letter and the past performance evaluation form (PPQ/CCASS) for this project; otherwise, in order for the submitted information to be considered, an acceptable explanation must be provided above.

Construction Contract:

2. Contract/Project No.: Delivery/Task Order Number:

Title:

Location:

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

Completion Date (mm/dd/yy): Final Price: $

This is the: total project subcontract price

4. Type of Contract: Design-Build (designed and constructed under a single contract)

(check one) Design-Bid-Build (bid from fully-designed plans and specifications)

Other (explain):

If D-B, design firm was:

Firm is not a member of the proposed team for this MACC Firm is Team Member # from Exhibit “A”

Customer:

5. Name:

Point of Contact Name/Title:

POC Phone Number: POC Email Address:

Project Description:

This project was primarily New construction Renovation (see definition; check one box only).

6. Provide a detailed description of the project and its relevancy to the intended work of this MACC. Include the features of work that demonstrate the project was primarily new construction or primarily renovation.

7. Percentage of work your firm self-performed (see definition): % Provide a detailed description of the relevant work your firm self-performed on this project:

EXHIBIT “C”

NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)

CONTRACT INFORMATION

1. Contractor Information Firm Name: CAGE Code:

Address: DUNs Number:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work High Med Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION

5. Client Information Name:

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: NAVFAC REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO NAVFAC WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON NAVFAC SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO NAVFAC. PLEASE CONTACT THE OFFEROR FOR NAVFAC POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO

VERIFY ANY AND ALL INFORMATION ON THIS FORM.

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING DEFINITION NOTE

(E) Exceptional Performance meets contractual requirements and exceeds many to the Government’s/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating.

Also, there should have been NO significant weaknesses identified.

(VG) Very Good Performance meets contractual requirements and exceeds some to the Government’s/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been NO significant weaknesses identified.

(S) Satisfactory Performance meets minimum contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract.

There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

(M) Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor's proposed actions appear only marginally effective or were not fully implemented.

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

(U) Unsatisfactory Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating.

(N) Not Applicable No information or did not apply to your contract Rating will be neither positive nor negative.

Contractor Information (Firm Name): ________________________________________________ Client Information (Name): ________________________________________________________

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY

a) Quality of technical data/report preparation efforts E VG S M U N

b) Ability to meet quality standards specified for technical performance E VG S M U N

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance

E VG S M U N

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance)

E VG S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below)

E VG S M U N

b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract

E VG S M U N

3. CUSTOMER SATISFACTION

a) To what extent were the end users satisfied with the project? E VG S M U N

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes;

responsiveness to administrative reports, businesslike and communication)

E VG S M U N

c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

E VG S M U N

d) Overall customer satisfaction E VG S M U N

4. MANAGEMENT/PERSONNEL/LABOR

a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force

E VG S M U N

b) Ability to hire, apply, and retain a qualified workforce to this effort E VG S M U N

c) Government Property Control E VG S M U N

d) Knowledge/expertise demonstrated by contractor personnel E VG S M U N

e) Utilization of Small Business concerns E VG S M U N

f) Ability to simultaneously manage multiple projects with multiple disciplines E VG S M U N

g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes

E VG S M U N

h) Effectiveness of overall management (including ability to effectively lead, manage and control the program)

E VG S M U N

5. COST/FINANCIAL MANAGEMENT

a) Ability to meet the terms and conditions within the contractually agreed price(s)

E VG S M U N

Contractor Information (Firm Name): ________________________________________________ Client Information (Name): ________________________________________________________

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client.

E VG S M U N

c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns).

E VG S M U N

d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section.

Yes No

e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

Yes No

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

Yes No

6. SAFETY/SECURITY

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues?

(Includes: following the user’s rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

E VG S M U N

b) Contractor complied with all security requirements for the project and personnel security requirements.

E VG S M U N

7. GENERAL

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

E VG S M U N

b) Compliance with contractual terms/provisions (explain if specific issues) E VG S M U N

c) Would you hire or work with this firm again? (If no, please explain below) Yes No

d) In summary, provide an overall rating for the work performed by this contractor.

E VG S M U N

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

EXHIBIT “D”

SAFETY DATA SHEET

N62473-17-R-1413 This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. EMR, DART and TRC rates shall not be submitted for subcontractors.

Joint Venture (JV) or Partnership: Complete Blocks 1 through 8 for each contractor who is part of the JV or partnership. Only one safety narrative (Block 9) is required.

1. Offeror Name:

Name of JV partner providing the information below (if applicable):

Offeror’s Three Previous Complete Calendar Years of Reported Safety Data:

Only complete year safety data will be considered. Indicate data rates as decimal figures, not whole numbers.

2. Experience Modification Rate (EMR):

2015 2016 2017

3a. For EMRs greater than 1.0, explain any extenuating circumstances and corrective actions taken:

3b. Explain any negative EMR trends:

3c. If you do not have an EMR for a given year, state so here and explain why:

4. Insurance Carrier Information:

Insurance Carrier Name:

Agent’s name: Phone No.: Email:

5. U.S. Dept. of Labor, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate

Instructions for calculating the DART rate can be found at http://www.bls.gov/iif/osheval.htm.

6a. For DART Rates of 3.0 or greater, explain any extenuating circumstances and corrective actions taken:

6b. Explain any negative DART Rate trends:

6c. If you do not have a DART Rate for a given year, state so here and explain why:

EXHIBIT “D” (continuation)

SAFETY NARRATIVE

N62473-17-R-1413

7. U.S. Dept. of Labor, OSHA Total Recordable Case (TRC)

Rate

Instructions for calculating the TRC rate can be found at http://www.bls.gov/iif/osheval.htm.

8a. For TRC Rates of 4.5 or greater, explain any extenuating circumstances and corrective actions taken:

8b. Explain any negative TRC Rate trends:

8c. If you do not have a TRC Rate for a given year, state so here and explain why:

N62473-17-R-1413

9. Technical Approach for Safety: Provide the Safety Narrative using this form. Do not exceed page limitation specified in the RFP. Any additional pages will not be considered.

Describe the plan that the Offeror will implement to evaluate safety performance of potential subcontractors, as a part of the selection process for all levels of subcontractors:

Describe the safety management system that the Offeror will use to oversee the safety compliance and performance of self-performed and subcontractor performed work:

Note: Form may be expanded up to the page limit specified in the RFP.

N62473-17-R-1413

9. Technical Approach for Safety (continuation): Provide the Safety Narrative using this form. Do not exceed page limitation specified in the RFP. Any additional pages will not be considered.

Describe any innovative methods that the Offeror will employ to ensure and monitor safe work practices at self-performed/and or all subcontractor levels:

Describe the methodology that the Offeror will use in order to execute an effective program that facilitates sound mishap prevention techniques and processes, employee reporting of unsafe conditions, unsafe activities, and near-miss mishaps:

EXHIBIT J

PRE-AWARD CONTRACTOR’S SELF-PERFORMANCE CERTIFICATION

AND NOTIFICATION OF SUBCONTRACTING

From: Company Name, Street Address, City, State, Zip

To: Name of Contracting Officer, FEAD/Office Name, Naval Facilities Engineering Command, Southwest

Subj: Contract No. N62473-XX-X-XXXX

1. In accordance with the provisions of DFARS Clause 252.219-7009, Section 8(a) Direct Award (Sep 2007), paragraph (c)(2), the Contracting Officer is hereby notified that Company intends to subcontract the following portion(s) of the requirements of this contract:

SUBCONTRACTOR INFORMATION

TYPE OF WORK TO BE

SUBCONTRACTED

DOLLAR VALUE TO BE

SUBCONTRACTED

NAME:

ADDRESS:

CAGE/DUNS:

PRIMARY NAICS:

COMPANY SIZE:

POC:

PHONE:

EMAIL:

NAME:

ADDRESS:

CAGE/DUNS:

PRIMARY NAICS:

COMPANY SIZE:

POC:

PHONE:

EMAIL:

* * Table may be expanded as needed.

2. Furthermore, in accordance with the provisions of FAR 52.219-14, Limitations on Subcontracting (Nov 2011), by submission of an offer and execution of this contract, Company agrees that in performance of this contract, in the case of a contract for –

(a) Services (except construction) - At least 50% of the cost of contract performance incurred for personnel shall be expended for employees of the concern.

(b) Supplies (other than procurement from non-manufacturer of such supplies) - The concern shall perform work for at least 50% of the cost of manufacturing the supplies, not including the cost of materials.

(c) General construction - The concern will perform at least 15% of the cost of the contract, not including the cost of materials, with its own employees.

(d) Construction by special trade contractors - The concern will perform at least 25% of the cost of the contract, not including the cost of materials, with its own employees.

3. Additionally, Company certifies that they will self-perform the following work –

DESCRIPTION OF WORK DOLLAR VALUE OF WORK

* * Table may be expanded as needed.

Note: Dollar value of subcontracted work plus self-performed work should equal total award.

4. No changes in subcontractors are allowed without prior written approval of the Contracting Officer and the SBA. The contractor shall notify the Contracting Officer and its SBA servicing center a minimum of 10 business days prior to any needed change.

The contractor shall not proceed with any requested change in advance of written approval from the Contracting Officer and the SBA.

CONTRACTOR:

SIGNATURE NAME AND TITLE DATE

CONTRACTING OFFICER APPROVAL:

SBA APPROVAL:

EXHIBIT K

POST-AWARD CONTRACTOR’S LIMITATIONS

ON SUBCONTRACTING CERTIFICATION

From: Contractor Name, Street Address, City, State, Zip

To: Name of Contracting Officer, FEAD/Office Name, Naval Facilities Engineering Command, Southwest

Subj: Contract No. N62473-XX-X-XXXX

1. Prime contractor is to complete and submit the following for each reporting period (6 months) for each performance period (Base Year and Options)

Block 1

Period of

Performance

Block 2

FFP &

Task Order #

(list TO#)

Block 3

Prime Labor Cost

Block 4

Subcontractor Labor Cost

Block 5

Total FFP or Task Order Labor Cost

Block 6

% Cost Performed by

Prime

Block 7

% Cost Performed by Subcontractor

Base Period

(Insert reporting period dates)

FFP

TO # 0001

TO # 0002

** add rows here

TOTAL FOR REPORTING

PERIOD

Base Period

(Insert reporting period dates)

TO XXXX

TO XXXX

Etc.

** add rows here

TOTAL FOR REPORTING

PERIOD

TOTAL PERFORMANCE PERIOD

(Base Year)

2. Furthermore, in accordance with the provisions of FAR 52.219-14, Limitations on Subcontracting (Nov 2011), 13 CFR 124.510 and 13 CFR 125.6, in the performance of this contract, In the case of a contract for services (except construction), your Company Name has performed at least 50 percent of the cost of the contract incurred for personnel with its own employees.

In the case of a contract for supplies or products (other than procurement from a non-manufacturer in such supplies or products your Company Name has performed at least 50 percent of the cost of manufacturing the supplies or products (not including the costs of materials).

In the case of a contract for general construction, your Company Name has performed at least 15 percent of the cost of the contract with its own employees (not including the costs of materials).

In the case of a contract for construction by special trade contractors, your Company Name has performed at least 25 percent of the cost of the contract with its own employees (not including the cost of materials).

I certify that to the best of its knowledge and belief, the information provided in this report is accurate, complete, and current as of the date of report.

CONTRACTOR:

Attachment 1 - Financial Questionnaire
Exhibit A - Offeror Team Composition and Management
Exhibit B - Experience - Designer
Exhibit B - Experience - Offeror
Exhibit C - PPQ
Exhibit D - Safety Data
Exhibit J - Pre-Award-Contractor-Self-Performance-Certification
Exhibit K - Post-Award-Limitations-on-Subcontracting-Report

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