Performance Relevancy Survey Form - 626A4-19-101 Renovate Ward 1B.docx
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- Attached to
- Z2DA--626A4-19-101 - Renovate Ward 1B at the Alvin C. York VA Medical Center, Murfreesboro, TN 37129
- Solicitation number
- 36C24923R0114
About this file
This document is a performance relevancy survey form for solicitation number 36C24923R0114 to renovate Ward 1B at the Alvin C. York VA Medical Center in Murfreesboro, Tennessee. Offerors are required to provide details of up to three relevant past performance projects from the last five years, including descriptions of work performed, completion dates, contract values, points of contact, and any notable modifications. Additional information requested includes names and roles of proposed subcontractors; assessments of liquidated damages from previous contracts; descriptions of value engineering proposals, industry awards, and unique skills; and contact information for the offeror. The solicitation is issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9 for renovation services at a VA medical center.
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Text version
FOR OFFICIAL USE ONLY
Source Selection Sensitive Information—See FAR 2.101 & 3.104 626A4-19-101 - Renovate Ward 1B 36C24923R0114
PERFORMANCE RELEVANCY SURVEY
PART 1: Provide the following information requested in this format for each of the projects/contracts you intend to have considered for evaluation. Projects may be on-going and cannot have been completed any later than 5 years prior to the proposal due date. Provide frank, concise comments regarding YOUR PERFORMANCE on the contracts you elect to reference.
A. Offeror (Your) Name (Company/Division):
B. Project/Contract Title:
C. Contract Specifics:
| 1. Description of Effort as __________ | Prime | or | ______Subcontractor |
| 2. Contract Number | __________ | ||
| 3. Original Contract $ Value ________ | Current/Final Contract $ Value ____________ | ||
| 4. If amounts in 3 above are different, provide a brief description of the reason: | |||
| 5. Completion Date(s): | |||
| a. Original Date: ______________________ |
b. Current Schedule____________________
| c. Estimate/Final Completion Date:_____________________ |
| d. Primary cause for Contract Modifications______________ |
D. Provide detailed description of the work performed under the contract and describe why you believe the work is VERY REVELANT, RELEVANT, or SNOT-RELEVANT. Descriptions must address the following:
1. Describe the specific elements of the work performed by your firm.
2. Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on this requirement. Should you intend to use these same subcontractors, please list their company names and described their principal areas of work that they will perform.
3. Address any technical areas about this project you consider uniquely relevant to this solicitation.
E. Point of Contact for Owner/Government agency Contracting Officer and or inspector (COR); include a current phone number, email address and facsimile number for each.
Company Name:
| Point of Contact: | Title: | E-mail: | __ | |||
| Office Phone: | _______________ | Fax: | _ |
Address of Record:
PART 2: Additional offeror information required, but not project specific. This information need only be provided once in your submission package.
A. Name subcontractors and/or Teaming Partners to be utilized on this contract. Multiple subcontractors may be named for the same discipline, but are limited to a maximum of three (3) subcontractors per discipline. As a minimum, provide the name(s) of subcontractors to be utilized in the following areas:
Plumbing
HVAC:
Electrical:
Roofing:
Testing, Civil Site Work:
Each major subcontractor and/or Teaming Partner must also complete a Subcontractor Information and Consent Form to be considered.
Written references for subcontractors may be included and are encouraged. However, subcontractors do not need to send out questionnaires.
B. Provide information regarding the assessment of liquidated damages on any contracts within the last five years. (Frequency, circumstances, severity of problem, etc.)
C. Offerors are strongly encouraged to include with their proposals information on problems encountered on relevant projects and the specific corrective actions taken to remedy the problems.
D. Other Past Performance Considerations. Information provided, shall be limited to the period starting 5 years prior to the solicitation release date and may include the following:
| 1. | Effectiveness of value engineering (VEC) proposals you submitted on prior contracts. (Provide a | brief description; impact on cost, schedule, efficiency or quality; contract number; name and | phone number of customer benefiting from the VEC). |
| 2. | Professional/Industry awards (Identify award type, date of award and copy of certificate if | applicable), Letters of appreciation, recognition or commendations | |
| 3. | Discuss unique skills and accomplishments (Explain unique skills and/or accomplishments and | provide supporting information for verification). |
Company Name:
| Point of Contact: | Title: | E-mail: | __ | |||
| Office Phone: | _______________ | Fax: | _ |
Address of Record:
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