P02 - Sources Sought Notice Attachment One - Past Performance Survey.pdf

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SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104

FOR OFFICIAL USE ONLY

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: (Contractor to be evaluated)

Telephone Number: Fax Number:

Address: Point of Contact:

E-mail:

Project Title and Brief Description of Work: ______________________________________ *

Contract Number Provided by Offeror: _____________________ Dollar Amount: _______ *

Contract Period or Dates of Performance Provided by Offeror: * Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 5 years, please complete separate evaluation forms for those contracts as well.

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SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104

FOR OFFICIAL USE ONLY

P02 - Sources Sought Notice Attachment One (1) - Past Performance Survey

SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104

FOR OFFICIAL USE ONLY

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number:

Email Address:

E-MAIL COMPLETED SURVEY FORM TO: ov

PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) .

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets/met contractual requirements with many exceeded to the benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets/met contractual requirements with some exceeded to benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets/met contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet/did 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 or the proposed actions appear only marginally effective or were not fully implemented.

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

Performance was not observed or not applicable to the current effort being reported against.

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SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104

FOR OFFICIAL USE ONLY

and apolinar.vargas@va.gov.

SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 3.104

FOR OFFICIAL USE ONLY

CONTRACT NUMBER:

The contractor:

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

1 2 3 4 5 6 NA

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

1 2 3 4 5 6 NA

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

1 2 3 4 5 6 NA

4. Home office participated in solving significant local problems. 1 2 3 4 5 6 NA

5. Followed approved quality control plan. 1 2 3 4 5 6 NA

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

1 2 3 4 5 6 NA

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

1 2 3 4 5 6 NA

8. Provided timely resolution of contract discrepancies. 1 2 3 4 5 6 NA

9. Identified risks/problems as they occurred. 1 2 3 4 5 6 NA

10. Suggested alternative approaches to problems. 1 2 3 4 5 6 NA

11. Displayed initiative to solve problems. 1 2 3 4 5 6 NA

12. Developed realistic progress schedules. 1 2 3 4 5 6 NA

13. Met established project schedules. 1 2 3 4 5 6 NA

14. Provided timely resolution of warranty defects. 1 2 3 4 5 6 NA

15. Was responsive to contract changes. 1 2 3 4 5 6 NA

16. Provided adequate project supervision. 1 2 3 4 5 6 NA

17. Obtained consent of surety for increases in bonding as work-in-progress increased.

1 2 3 4 5 6 NA

18. Paid subcontractors/suppliers in a timely manner. 1 2 3 4 5 6 NA

19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

1 2 3 4 5 6 NA

20. With respect to the safety plan, the contractor:

a. Followed the approved safety plan. 1 2 3 4 5 6 NA

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SOURCE SELECTION SENSITIVE IAW FAR 2.101 AND FAR 4.104

FOR OFFICIAL USE ONLY

b. Had no significant safety problems at the job site. 1 2 3 4 5 6 NA

21. The contractor met contractual requirements for the following work elements:

a. 1 2 3 4 5 6 NA

b. 1 2 3 4 5 6 NA

c. 1 2 3 4 5 6 NA

d. 2 3 4 5 6 NA

e. 1 2 3 4 5 6 NA

f. 1 2 3 4 5 6 NA

22. Cooperated with Government personnel after award. YES NO

23. Was the contractor ever issued a cure or show cause notice under YES NO

24. Would you award another contract to this contractor? If not, YES NO

25. Has contractor demonstrated a history of environmental YES NO

26. How would you rate the contractor's overall performance? 1 2 3 4 5 6 NA

Remarks:

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