S02_Past Performance Questionnaire.docx
DOCX document 38 KB Posted
- Attached to
- Z2JZ--FY24: NRM (PROJ: 516-23-604) Install Temp Shoring in Crawl Space at Building 1 (Specialized Contract)
- Solicitation number
- 36C24824Q0071
About this file
This document contains a past performance questionnaire for a contractor bidding on a Department of Veterans Affairs contract. The questionnaire requests performance ratings and narrative explanations for ratings of unsatisfactory or marginal on a scale of 1 to 6. It also asks if the reference would award another contract to the contractor and whether the contractor is rated in the Contractor Performance Assessment Reporting System. The related federal contract opportunity is for project number 516-23-604 to install temporary shoring in the crawl space at Building 1 at the Veterans Health Administration Veterans Integrated Service Network 8. Responses to the questionnaire are due by November 24, 2023.
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Other files
| File | Type | Posted |
|---|---|---|
| RFI QA Temporary Shoring Crawl Space BPVAMC-516-23-604-RFI 12072023.xlsx | XLSX spreadsheet | |
| 36C24824Q0071 0005_1.docx | DOCX document | |
| Temp Shoring Site Visit Sign in Sheet.pdf | ||
| 36C24824Q0071 0004_1.docx | DOCX document | |
| RFI QA Temporary Shoring Crawl Space BPVAMC-516-23-604-RFI 11302023.xlsx | XLSX spreadsheet | |
| 36C24824Q0071 0003.docx | DOCX document | |
| RFI QA Temporary Shoring Crawl Space BPVAMC-516-23-604-RFI.xlsx | XLSX spreadsheet | |
| 516-23-604 2023 11 09 Site Walk Sign In.pdf | ||
| 36C24824Q0071 0002_1.docx | DOCX document | |
| 07_Specifications_516-23-604_Specialized-Services _Rev1.pdf | ||
| 36C24824Q0071 0001_1.docx | DOCX document | |
| S02_Portion of JS Held Report.pdf | ||
| S02_SCA WD 2015-4571.txt | TXT text file | |
| 36C24824Q0071_1.docx | DOCX document | |
| S02_Specifications_516-23-604_Specialized-Services.pdf | ||
| 36C24824Q0071.pdf | ||
| S02_SOW_Specialize_Service_Rev1_Final_w-Appendices 05_516-23-604_2023.pdf | ||
| S02_ EMR.pdf | ||
| List of Attachments.pdf |
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Text version
PAST AND PRESENT PERFORMANCE QUESTIONNAIRE
INSTRUCTIONS TO CONTRACTOR
Complete the CONTRACTOR INFORMATION section below (type answers into light blue shaded boxes). Save the document. Send an electronic or hard copy print of the form to each reference contact, asking them to complete the form and submit it according to the instructions below.
INSTRUCTIONS TO REFERENCE CONTACT
The contractor named below is submitting an offer for a United States Department of Veterans Affairs contract requirement and has sent this form to you in your role as a past performance reference contact. Please complete this form (all areas shaded in light yellow below). Once completed, please send the form to the Contracting Officer via postal mail, email, or fax directly to:
Department of Veterans Affairs NCO 08 Contracting Office ATTN: Kenneth Caryer and Laurie Whitmore REF: Project 516-23-604 Temporary Shoring in the Crawl Space Email Address: Kenneth.Caryer@va.gov – Contracting Officer Email Address: Laurie.Whitmore@va.gov – Contracting Specialist
Please return the completed form no later than November 24, 2023, by 4:00 p.m.. If you have any questions, please email Contracting Specialist Laurie Whitmore. Thank you for your assistance in this matter.
GENERAL INFORMATION [completed by Contractor]
Contractor Company Name
Street Address
Contractor Point of Contact Name
City
Point of Contact Phone Number
State
Reference Project Title
Zip Code
Contract Period of Performance (start to finish):
Contract Number
Contract Dollar Value
Description of Work
Role of Contractor on This Project (check appropriate box) ☐ Prime Contractor ☐ Sub-contractor ☐ Key Personnel
RESPONDENT INFORMATION [completed by Reference Contact]
Company Name
Street Address
POC Name
City
Phone Number
State
Fax Number
Zip Code
PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2 in the Remarks section, below (text box will expand to whatever extent is necessary).
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| UNSATISFACTORY |
| MARGINAL |
| SATISFACTORY |
| VERY GOOD |
| EXCEPTIONAL |
| NEUTRAL |
| Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective. |
| Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective. |
| Performance met contractual requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory. |
| Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems, which the contractor resolved in a timely, effective manner. |
| Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner. |
| No record of past performance or the record is inconclusive.[endnoteRef:1] [1: ] |
| The Contractor … |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| 1. |
| Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 2. | |||||
| Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 3. | |||||
| Delegated authority to project managers and supervisors commensurate with contract requirements. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 4. | |||||
| Home office participated in solving significant local problems. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 5. | |||||
| Followed approved quality control plan. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 6. | |||||
| Provided effective quality control and/or inspection procedures to meet contract requirements. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 7. | |||||
| Corrected deficiencies in timely manner and pursuant to their quality control procedures. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 8. | |||||
| Provided timely resolution of contract discrepancies |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 9. | |||||
| Identified problems as they occurred. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 10. | |||||
| Suggested alternative approaches to problems. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 11. | |||||
| Displayed initiative to solve problems. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 12. | |||||
| Developed realistic progress schedules. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 13. | |||||
| Met established project schedules. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 14. | |||||
| Provided timely resolution of warranty defects. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 15. | |||||
| Was responsive to contract changes. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 16. | |||||
| Provided adequate project supervision. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 17. | |||||
| Obtained consent of surety for increases in bonding as work-in-progress increased. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 18. | |||||
| Paid subcontractors/suppliers in a timely manner. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 19. | |||||
| Provided accurate and complete line item cost proposals including all aspects of work required for each task. |
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 20. | |||||
| Cooperated with Government personnel after award. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 21. | |||||
| How would you rate the contractor's overall performance? | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 22. | |||||
| Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” | |||||
| ☐ | YES | ||||
| ☐ | NO |
| 23 | |
| Would you award another contract to this contractor? If not, please explain in “remarks.” | |
| ☐ | YES |
| ☐ | NO |
| 24 | |
| To the best of your knowledge, is the contractor rated in CPARS? | |
| ☐ | YES |
| ☐ | NO |
REMARKS (Please use as much space as is needed – the box will expand as you type).
Source Selection Sensitive IAW FAR 2.101 and 3.104
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