S02-EXHIBIT D CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY v2.pdf

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104

Project No. 629-20-106 – Rebalance HVAC System

36C25620R0099

EXHIBIT A

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 more than 3 years prior to the solicitation issue date. Provide frank, concise comments regarding YOUR

PERFORMANCE on the contracts you elect to reference.

A. Offeror 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. Estimated/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 SEMI-RELEVANT.

Very Relevant Present/past performance effort involved essentially the same scope and magnitude of effort and complexities this solicitation requires.

Relevant Present/past performance effort involved similar scope and magnitude of effort and complexities this solicitation requires.

Somewhat Relevant Present/past performance effort involved some of the scope and magnitude of effort and complexities this solicitation requires.

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 project.

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 / COTR);

include a current phone number, email address and facsimile number for each.

Company/Agency Name:

Point of Contact: Title:

Office Phone: Fax: E-mail:

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. Provide information regarding the assessment of liquidated damages on any contracts within the last three years. (Frequency, circumstances, severity of problem, etc.)

B. 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.

C. Other Past Performance Considerations. Information provided shall be limited to the period starting three years prior to the solicitation release date and may include the following:

1. 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:

Office Phone: Fax: E-mail:

Address of Record: