Past Performance Questionnaire for Construction.pdf

Revised 5/10/2012

PAST PERFORMANCE QUESTIONNAIRE FOR CONSTRUCTION

PLEASE HAVE THE REFERENCE COMPLETE AND SUBMIT DIRECTLY TO THE GSA AS SHOWN BELOW

NOT LATER THAN 3:00 PM MOUNTAIN ON MAY 19, 2021.

Submit DIRECTLY to: jennifer.canfield@gsa.gov

Section 1 – TO BE COMPLETED BY THE OFFEROR Name of Offeror/Firm: _______________________________________________________________________ Contract Number: __________________________________________________________________________ Total Contract Value (including modifications): ____________________________________________________ Contract Type: _____________________________________________________________________________ Period of Performance: ______________________________________________________________________ Place of Performance: _______________________________________________________________________ Percentage of Work Performed by Contractor: ___________% Description of Construction Work Performed: _____________________________________________________

Gross Square Footage of Facility: ______________________________________________________________

Briefly describe all construction work performed under this contract.

Section 2 – TO BE COMPLETED BY THE REFERENCE NOTE: If the offeror holds or has held other contracts with your agency/organization in the last five (5) years, please complete separate evaluation forms for those contracts as well.

Name of Respondent/Title: _____________________________________________ Firm Name: _____________________________________________ Address: _____________________________________________ Phone: _____________________________________________ Fax: _____________________________________________ Email: _____________________________________________

Thank you for your assistance! - Please contact me directly at 307-267-4392, if you have any questions or would like to offer additional information. – Jennifer Canfield, CO.

Performance Information: Please check the level of the Offeror’s overall performance in each of the business management factors listed below. Check “N/A:” if the factor does not apply to the contract being rated. . If any portion of the contract performance was performed by subcontractors, please include the subcontractor’s performance on the same chart.

KEY: Unsatisfactory - Performance did not meet most contract requirements.

Marginal - Performance did not meet some contract requirements.

Satisfactory - Performance met all contract requirements.

Very Good – Performance met all contract requirements and exceeded some.

Exceptional – Performance met all contract requirements and exceeded many.

1. Were claims filed during contract performance? YES ________ NO __________

2. Were liquidated damages assessed? YES ________ NO __________

3. Would you award to this contractor again? YES ________ NO __________

4. Could you provide another contact for further information? YES ________ NO __________

Name: _______________ Phone Number or Email ________________________ Additional Remarks: (Provide facts concerning specific events/actions to justify rating. Attach additional pages if necessary):

EVALUATION FACTOR Unsatisfactory* Marginal* Satisfactory Very Good

Exceptional N/A

Conformance to the scope of work and specifications

Quality of workmanship

Reasonable and cooperative behavior and commitment to customer satisfaction

Adequacy/implementation/ documentation of the Quality Control Plan

Storage and adequacy of materials

Adequacy of Submittals

Adequacy of As-Builts (if provided)

Identification/correction of deficient work in a timely manner

Effectiveness of management, including cooperation and responsiveness, management of resources/personnel, coordination and control of subcontractors

Adequacy of site cleanup, professional conduct, review and resolve subcontract issues.

Timely performance, adequacy of progress schedule, adherence to schedule, resolution of delays, completion of punch list items, and warranty response

Compliance with Labor Standards, correction of noted deficiencies, payrolls properly completed and submitted. Compliance with labor laws and regulations.

Adequacy of Safety Plan, implantation of Safety Plan, correction of noted deficiencies if applicable

Overall Rating of the Contractor’s Performance