S02 - Attachment 11 - Past Performance Questionnaire.docx
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- Attached to
- C1BG--A&E Design 436-21-700, EHRM Infrastructure Upgrades – Ft. Harrison, MT (VA-21-00039468)
- Solicitation number
- 36C77621R0108
About this file
This document is a presolicitation notice for architectural and engineering design services for electrical, HVAC and infrastructure upgrades at the VA Medical Center in Fort Harrison, Montana. Firms are requested to submit Standard Form 330 qualifications packages by May 21, 2021 for evaluation. The project has an estimated construction value between $10-20 million and requires a 100% Service-Disabled Veteran-Owned Small Business set-aside. The selected A/E firm will provide design and construction support services over a 242-day period. Evaluation criteria include specialized experience designing similar healthcare IT and facility projects, personnel qualifications, past performance, capacity, knowledge of local conditions, and experience providing construction support. The highest rated firm may receive a site visit as part of negotiations to determine a fair and reasonable contract price.
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Text version
ATTACHMENT 8 - PAST PERFORMANCE QUESTIONNAIRE
1. Contractor Information
Firm Name:
Address:
Phone Number:
Point of Contact:
Contact Phone Number:
DUNs Number:
2. Work Performed as: |_| Prime Contractor |_| Sub Contractor |_| Joint Venture |_| Other
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:
Project Description:
Complexity of Work |_| High |_| Med |_| Routine 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:
Rating: Please evaluate the past performance using only the following ratings without variation. DO NOT RATE ON A “+” OR “-“ SCALE. If a “+” or “-“ is used, the rating without the "+" or "-" will be applied. In addition to the ratings, please provide a short narrative in the appropriate block or in the remarks section of this form.
| “O” |
| 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. |
| “A” |
| 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. |
| “S” |
| 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. |
| “M” |
| Marginal |
| Performance did not meet some contractual requirements. Performance indicated that there are some potential risks associated with the quality products, timeliness of service, and contract performance. |
| “U” |
| Unacceptable |
| 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. |
Please rate and provide any supporting information/comments for the following:
| 1. The quality of the working relationship with the client (the tenant and/ or owner). |
| O A S M U |
| 2. The professionalism and integrity with which offeror conducted business. |
| O A S M U |
3. The responsiveness to the client’s needs and expectations.
O A S M U
| 4. The Offeror’s ability to successfully management and perform the project. |
| O A S M U |
| 5. The offeror’s level of communication. |
| O A S M U |
| 6. The quality control of the project. |
| O A S M U |
7. Any Value added to the project as the result of cost savings, favorable financing, positive asset management, etc.
Yes No
| 8. Would you award another contact to the party being evaluated? If no, please explain. |
| Yes No |
| 9. The delivery of the project within the budget and on schedule. |
| O A S M U |
10. Other relevant aspects in the management of a project development for the client.
| 11. Overall rating for this firm: |
| O A S M U |
Signature of Evaluator
Date
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