S02 EXHIBIT A Past Performance Info Sheet for Contractors.docx

4.31 PAST PERFORMANCE SHEET FOR CONTRACTORS

FIRM: ____________________________________________________________________________________________

CONTRACT NO: ___________________ PROJECT NO: ________________________ NAICS: ___________________

PROJECT TITLE: __________________________________________________________________________________

LOCATION: ______________________________________________________________________________________

CONTRACTING OFFICER/POC: _____________________________________________________________________

PHONE NO: ___________________________ E-MAIL ADDRESS: ___________________________________

OWNER’S PROJECT MANAGER/POC:________________________________________________________________

PHONE NO: ___________________________ E-MAIL ADDRESS: ___________________________________

TYPE OF CONTRACT (Negotiated, Design/Build):________________________________________________________

SQUARE FOOTAGE OF EXPANSION SPACE: ________________

SQUARE FOOTAGE OF RENOVATION SPACE: ______________

AWARD AMOUNT: $__________________________ FINAL AMOUNT: $___________________________________

AWARD DATE: ___________________________________________________________________________________

NOTICE TO PROCEED DATE: _______________________________________________________________________

ORIGINAL SCHEDULED COMPLETION DATE:________________________________________________________

ACTUAL COMPLETION DATE: _____________________________________________________________________

NUMBER OF CHANGE ORDERS AND REASON FOR CHANGES:

OSHA CITATIONS (If Applicable): ____________________________________________________________________

LIST ALL MAJOR SUBCONTRACTORS (W/POC & Phone Numbers):

DESCRIPTION OF PROJECT – ADDRESS PROJECT SCOPE OF WORK AND EXPLAIN HOW THE PROJECT INVOLVED WORK AS A PRIME CONTRACT WAS TECHNICALLY SIMILAR TO THE PROJECT DESCRIBED WITHIN THIS NOTICE. (May be continued on a blank page, if necessary):

4.32 PAST PERFORMANCE INFORMATION FORM

RFP 36C24123R0132, Fit Out, building 6 2nd Floor, VAMC Providence, RI Provide the following information requested in this format for each of the projects/contracts being described. Projects may be on going and cannot have been competed any later than Five (5) years prior to the solicitation issue date.

OFFEROR: ____________________________________________________________________

CONTRACT NO.________________PROJECT NO.__________________ NAICS: __________

PROJECT TITLE: _______________________________________________________________

LOCATION: __________________________________________________________________

CONTRACTING OFFICER/POC: __________________________________________________

PHONE NO: ________________ E-MAIL ADDRESS: ___________________________

OWNER’S PROJECT MANAGER/POC_____________________________________________

PHONE NO: ________________E-MAIL ADDRESS: ____________________________

ARCHITECT/ENGINEER/POC____________________________________________________

PHONE NO: ___________________ E-MAIL ADDRESS: _________________________

TYPE OF CONTRACT (Negotiated, Design/Build, Design/Bid/Build) _______________________________________

SQUARE FOOTAGE: _______ FOUNDATION TYPE:________

AWARD AMOUNT: $___________________ FINAL AMOUNT: $_______________________

ORIGINAL SCHEDULED COMPLETION DATE:________________________________________________________

ACTUAL COMPLETION DATE: _____________________________________________________________________

OSHA CITATIONS (If Applicable ) ____________________________________________________________________

LIST ALL MAJOR SUBCONTRACTORS (W/POC & Phone Numbers)

Modifications:_________________________________________________________________________

DESCRIPTION OF PROJECT – Address project scope of work and explain how the project involved work as a prime contract was technically similar to the project under this solicitation. (May be continued on a blank page, if necessary)

In addition, address the following (May be continued on a blank page, if necessary):

Describe the specific elements of the work performed by your firm ______________________________

Indicate what elements of work were performed by your major subcontractors and indicate if those same subcontractors will be used on this project _______________________________________________

Address any technical areas about this project you consider uniquely relevant to this solicitation _____

· Include a current phone number and email address for point of Contact for Owner/Government agency Contracting Officer and or inspector.

4.33 SUBCONTRACTOR INFORMATION AND CONSENT FORM

Subcontractor and/or Teaming Partner Consent for the Release of Past Performance Information to the Prime Contractor and Reference Information Past performance information concerning subcontractors and teaming partners cannot be disclosed to a private party without the subcontractor’s or teaming partner’s consent. Because a prime contractor is a private party, the Government will need that consent before disclosing subcontractor/teaming partner past and present performance information to the prime during exchanges. In an effort to assist the Government in assessing your past performance relevancy we request that the following consent form be completed by the major subcontractors/teaming partners identified in your proposal. The completed consent forms should be submitted to the offering contractor for submission with past performance volume.

___________________(Name of Firm) is currently planning on participating as a (subcontractor and or a teaming partner) with ___________________(prime contractor or name of entity providing proposal) in responding to the Request for Proposal No.: 36C24123R0132 for construction projects issued by the Department of Veterans Affairs- VAMC Providence, RI.

We understand that the Government is placing increased emphasis on past performance in order to obtain best value in source selections. In order to facilitate the performance confidence assessment process, we are signing this consent form to allow you to discuss our past and present performance information with the prime contractor during the source selection process.

Company Name: ________________________ Telephone #____________________

Address: ______________________________

City/State/Zip Code: ______________________ Date:_____________________

Reference List (required):

1. Contract No. And Title___________________________________________________________ Describe your role (Prime/Sub) and work Performed ___________________________________ Reference POC Name____________________________ Phone___________ Fax____________ Email address: _________________________________________________________________

2. Contract No. And Title___________________________________________________________ Describe your role (Prime/Sub) and work Performed ___________________________________ Reference POC Name____________________________ Phone___________ Fax____________ Email address: _________________________________________________________________

3. Contract No. And Title___________________________________________________________ Describe your role (Prime/Sub) and work Performed ___________________________________ Reference POC Name____________________________ Phone___________ Fax____________ Email address: _________________________________________________________________

4.34 CALCULATION OF SELF-PERFORMED WORK

SUBMITTED IN RESPONSE TO RFP # 36C24123R0132 (Line Item 0001 Base Offer)

Self-Performance for General Construction Contracts = 15%

Use this form to identify and calculate cost of the work to be self-performed. (Includes mobilization and utilization of owned or rented plant and equipment to be operated by the prime contractor’s own employees; only those materials which will be both purchased and installed by the prime’s own forces; labor associated with those aforementioned materials or equipment; only those supplies to directly support work performed by the contractor’s own employees; and the contractor’s own job overhead costs.)

A.1 Clearly describe the trades and the work to be self-performed by your company:

A.2 Clearly describe the trades and the work which will be subcontracted for this project:

Show Calculation of Self-Performed work

B.1 Total Offer Price: $_________________

B.2 Subtract G&A, home office overhead, $(__________________) prime contractor’s markups for profit, bond, state use tax, etc.

B.3“Total amount of work to be performed $___________________ under the Contract”

B.4 “Work to be self-performed”: = $ _________________________________

(Includes mobilization and utilization of owned or rented plant and equipment to be operated by the prime contractor’s own employees; only those materials which will be both purchased and installed by the prime’s own forces; labor associated with those aforementioned materials or equipment; only those supplies to directly support work performed by the contractor’s own employees; and the contractor’s own job overhead costs.)

B. 5. Self-performed Work = Line B.4 / B.3 X 100% = ________________________%