S02 - SOW Attachment 5 - Past Performance Questionnaire.docx
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- Solicitation number
- 36C77621R0058
About this file
This document is a presolicitation notice for architectural and engineering services related to EHRM infrastructure upgrades at the Hines VA Medical Center in Hines, Illinois. The project requires design and construction period services for network infrastructure installation, renovations, and upgrades to information technology systems. Responses are due by March 11, 2021. The anticipated period of performance for design completion is 180 calendar days from award. The contract value is estimated between $20-50 million. This opportunity is 100% set aside for service-disabled veteran-owned small businesses. The selection process will evaluate responses based on specialized experience, professional qualifications, capacity, past performance, locality, and construction period services. The highest rated firm may receive discussions and negotiations for award.
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Text version
ATTACHMENT 5 - 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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