Past Performance Questionnaire_Healthcare A-E DRAFT.pdf

PRE-DECISIONAL

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

SECTION 1

CONTRACT INFORMATION – Contractor to complete #1-3

1. CONTRACTOR INFORMATION

NAME OF OFFEROR BEING EVALUATED: Click or tap here to enter text.

ADDRESS: Click or tap here to enter text.

POINT OF CONTACT: Click or tap here to enter text.

CONTACT PHONE NUMBER: Click or tap here to enter text.

CONTACT EMAIL ADDRESS: Click or tap here to enter text.

WORK PERFOMED AS: Click or tap here to enter text.

PERCENT OF PROJECT WORK PERFORMED: Click or tap here to enter text.

IF SUBCONTRACTOR, WHO WAS THE PRIME? Click or tap here to enter text.

2. CONTRACT INFORMATION

CONTRACT TITLE: Click or tap here to enter text.

CONTRACT NUMBER AND DO/TO NUMBER: Click or tap here to enter text.

CONTRACT TYPE Choose an item.:

if other:

CONTRACT LOCATION: Click or tap here to enter text.

AWARD DATE: Click or tap to enter a date.

ORIGINAL CONTRACT ACCCEPTANCE (construction accepted) Date: Click or tap to enter a date.

ACTUAL CONTRACT ACCEPTANCE: Click or tap to enter a date.

EXPLAIN DIFFERENCES: Click or tap here to enter text.

ORIGINAL IMPLEMENTATION PRICE: Click or tap here to enter text.

ORIGINAL CONTRACT PRICE (all costs - design/installation/financing): Click or tap here to enter text.

FINAL CONTRACT PRICE (including modifications, if applicable): Click or tap here to enter text.

EXPLAIN DIFFERENCES: Click or tap here to enter text.

3. PROJECT DESCRIPTION

SCOPE INCLUDED IN PROJECT: Click or tap here to enter text.

HOW IS THIS PROJECT RELEVANT TO PROJECT OF SUBMISSION? Click or tap here to enter text.

SECTION 2

EVALUATOR INFORMATION – Client to complete

The U.S. Department of Veterans Affairs (VA) Office of Construction & Facilities Management (CFM) is considering the Offeror identified above for award of an Indefinite-Delivery, Indefinite Quantity (IDIQ) contract under the national healthcare Architect and Engineer (A-E) Multiple Award Task Order Contract (MATOC) – 36C10F25R50014.

Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate the company’s ability to perform the work as described in the solicitation. Please verify the accuracy of the information in Section 1 and complete the questionnaire as thoroughly as possible. VA CFM may contact you in order to obtain any additional information regarding a contract award.

Please return your completed questionnaire to the Offeror to be incorporated into the SF330 submission. PPQs should NOT be submitted directly to VA CFM by the client. Refer to the solicitation for SF330 submission due date.

EVALUATOR INFORMATION

NAME OF EVALUATOR: Click or tap here to enter text.

POSITION: Click or tap here to enter text.

ADDRESS: Click or tap here to enter text.

PHONE: Click or tap here to enter text.

EMAIL: Click or tap here to enter text.

DESCRIBE YOUR ROLE IN THE PROJECT: Click or tap here to enter text.

*Please see Page 4 for Adjectival Ratings for the following:

1. QUALITY

Ability to meet quality design and/or construction standards specified for technical performance Choose an item.

Comments:

2. SCHEDULE/ TIMELINESS OF PERFORMANCE

Compliance with contract delivery/completion schedules including timely submission of data deliverables (If liquidated damages were assessed or the schedule was not met, please address below.)

Choose an item.

Comments:

3. COMMUNICATION

Contractor was reasonable and cooperative in dealing with client staff (including the ability to successfully resolve disagreements/disputes and responsiveness to client requests)

Choose an item.

Comments:

4. MANAGEMENT/ PERSONNEL/ LABOR

Effectiveness of management, including suppliers, materials, and/or labor force (including the ability to effectively lead, manage, and control the project) Choose an item.

Continuity in the contractor’s personnel during execution of the contract (e.g., one person or team that stayed with the project throughout the contract) Choose an item.

Comments:

5. COST/ FINANCIAL MANGEMENT

Ability to meet the terms and conditions within the contractually agreed price Choose an item.

Comments:

6. SUBCONTRACT MANAGEMENT

Ability to manage subcontracting effort, including any subcontracting issues, and the contractor’s ability to resolve the problems without extensive customer guidance

Choose an item.

Comments:

7. SUMMARY

Would you hire or work with this firm again? If no, please explain below. Choose an item.

Provide an overall rating for the work performed by this contractor. Choose an item.

ADDITIONAL COMMENTS:

EVALUATOR SIGNATURE: DATE:

ADJECTIVAL RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR

EVALUATION OF THE CONTRACTOR’S PERFORMANCE

*THIS PAGE WILL BE REMOVED FOR EVALUATION PURPOSES AND NOT BE COUNTED

TOWARD THE SF330 PAGE COUNT – IT IS FOR PPQ COMPLETION PURPOSES ONLY*

Rating Definition

Outstanding The Offeror’s performance met contractual requirements and exceeded many requirements to the Client’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the Offeror were highly effective.

Above Average The Offeror’s performance met contractual requirements and exceeded some requirements to the Client’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the Offeror were effective.

Satisfactory The Offeror’s performance met contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the Offeror were satisfactory.

Unsatisfactory Performance did not meet contractual requirements. The contractual performance reflected a serious problem for which the Offeror has yet to identify corrective actions or the Offeror’s proposed actions appear only marginally effective or were not fully implemented.

Not Applicable No information or did not apply to your contract.