EXPERIENCE PROJECT DATA SHEET – LEAD DESIGN FIRM
N62473-09-R-1610
This form is to be completed by the Lead Design Firm. The purpose of this form is to provide supporting project information for Factor 1, Experience. Only projects that fit within the parameters of this factor will be evaluated. All other projects will be removed and discarded prior to evaluation.
1. Project No. (check one): - 1 - 2 - 3 - 4 - 5
2. Contract Number, Delivery/Task Order Number, Project Number, Title, and Location:
3. Award Date (mm/dd/yy):
100% Design Completion Date (mm/dd/yy)(do not include PCAS or other post award support):
Construction Completion Date (mm/dd/yy): / 4. Final Estimated Construction Cost (ECC) (Including all options):
5. Type of Work (check all that apply):
New Construction Renovation Repair Alteration
6. Type of Contract (check one):
Design-Build. If Design-Build, identify the Construction Contractor: ______
Fully Designed Project
Other (fully explain): ______
7. Name of Firm Who Performed the Work:
______
In what capacity did the firm perform the work on this project (check one):
Lead Design Firm Consultant
If the firm was a consultant on this project, identify the Lead Design Firm:
______
If the firm who performed this project differs from the firm proposing on this contract, identify relationship to the firm:
Subsidiary Satellite Office
Key Personnel Parent Company
Predecessor Company Other:______
If this project was performed by key personnel, identify the individual, firm they worked for, and how they were involved:
______
______/ 8. Customer/Owner Information:
Customer/Owner Name:
Point of Contact(person who has project knowledge and can answer questions):
Phone Number:
Email Address:
9. If this project was performed by key personnel, a subsidiary, satellite office, parent company, or predecessor company, explain how this office/person will participate in this contract.
10. Provide a detailed description of the project.
11. If project is design-build, provide a detailed description of the design effort.
12. Provide a detailed description of what work your firm self-performed on this project.
13. Describe specific sustainable design featuresthat were incorporated into this project. If the project is registered USGBC LEED Certified, submit a copy of the certificate with this exhibit.
Note: Form may be expanded.
Exhibit “A” – Experience - Lead Design Firm, Page 1 of 2
(Rev 04/09)
EXHIBIT “A”EXPERIENCE PROJECT DATA SHEET – OFFEROR
N62473-09-R-1610
This form is to be completed by the Offeror. The purpose of this form is to provide supporting project information for Factor 1, Experience. Only projects that fit within the parameters of this factor will be evaluated. All other projects will be removed and discarded prior to evaluation.
1. Project No. (check one): - 1 - 2 - 3 - 4 - 5
2. Contract Number, Delivery/Task Order Number, Project Number, Title, and Location:
3. Award Date (mm/dd/yy):
Completion Date (mm/dd/yy):
Is project at least 80% complete: Yes No
If yes, what percentage: ______% / 4. Award Amount:
Final Contract Price
(Including all options) :
Is this the total project or subcontract price
5. Type of Work (check all that apply):
New Construction Renovation Repair Alteration
6. Type of Contract (check one):
Design-Build. If Design-Build, identify the Lead Design Firm: ______
Fully Designed Project
Other (fully explain): ______
7. Name of Firm Who Performed the Work:
______
In what capacity did the firm perform the work on this project (check one):
Prime Contractor Subcontractor
If the firm was a subcontractor on this project, provide name of the prime contractor:
______
If the firm who performed this project differs from the Offeror proposing on this contract, identify relationship to the Offeror:
Subsidiary Satellite Office
Key Personnel Parent Company
Predecessor Company Other:______
If this project was performed by key personnel, identify the individual, firm they worked for, and how they were involved:
______
______/ 8. Customer/Owner Information:
Customer/Owner Name:
Point of Contact(person who has project knowledge and can answer questions):
Phone Number:
Email Address:
9. If this project was performed by key personnel, a subsidiary, satellite office, parent company, or predecessor company, explain how this office/person will participate in this contract.
10. Provide a detailed description of the project.
11. If project is design-build, provide a detailed description of the design effort.
12. Provide a detailed description of what work your firm self-performed on this project.
13. Describe specific sustainable design features that were incorporated into this project. If the project is registered USGBC LEED Certified, submit a copy of the certificate with this exhibit.
Note: Form may be expanded.
Exhibit “A” – Experience - Offeror, Page 2 of 2
(Rev 04/09)
EXHIBIT “B”
PAST PERFORMANCE QUESTIONNAIRE (PPQ) – LEAD DESIGN FIRMN62473-09-R-1610
Naval Facilities Engineering Command Southwest in San Diego, CA is considering the Lead Design Firm listed below. Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate commercial projects. If the referenced project is a government project, you may forward a copy of the official performance evaluation. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation (15.506) prohibits the release of the names of individuals providing reference information about an Offeror’s past performance. However, the solicitation requires the Past Performance Questionnaire (PPQ) be sent back to the contractor to be submitted in their proposal. So, to avoid having to fill out Past Performance Questionnaires for the same contractor/project numerous times, you may forward the questionnaire back to the contractor to be kept on file for any subsequent proposal submissions. If you do not want the contractor to have a copy of the completed PPQ, you may return it to this office by facsimile at
(619) 532-4789 prior to the proposal due date. In order to maintain the integrity of the source selection process, it is respectfully requested that you do not divulge the name of the Lead Design Firm, nor discuss your comments on this questionnaire with any other individuals.
Past Performance Information:
Name and Address of Lead Design Firm being evaluated:
Contract Number/Delivery or Task Order Number, Title, & Location:
Evaluator: (The following information will assist in the analysis of the data. Information will be kept confidential.)
Name of Evaluator:
Company/Agency Name:
Address:
Phone Number:
Position held or function in relation to project:
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. If the rating is Below Average or Poor, please provide additional information in the appropriate block or in the remarks section of this form.
“E” / Excellent / Performance greatly exceeded the contract requirements.
“AA” / Above Average / Performance exceeded the contract requirements.
“A” / Average / Performance met the contract requirements.
“B” / Below Average / Performance met the minimum contract requirements but some material aspects of the firm’s performance were less than satisfactory.
“P” / Poor / Performance was poor and/or did not satisfy contract requirements.
Please rate and provide any supporting information/comments for the following:
1. The relationship between the Lead Design Firm and client’s/customer’s contract team: / E AA A B P
2. The Lead Design Firm’s management and coordination of (sub)consultants: / E AA A B P
3. Overall corporate management, integrity, reasonableness, and cooperative conduct: / E AA A B P
4. Quality of work: / E AA A B P
5. Quality control procedures and execution: / E AA A B P
6. Management and adherence to the performance schedule: / E AA A B P
7. Ability/actions to improve schedule problems, if applicable: / E AA A B P
8. Meeting cost limitations: / E AA A B P
9. Plans/Specs accurate and coordinated: / E AA A B P
10. Plans clear and detailed sufficiently: / E AA A B P
11. Suitability of design: / E AA A B P
12. Have any letters of reprimand, suspension of payment, or termination been issued? If yes, please explain: / Yes No
13. Would you award another contract to the party being evaluated? If no, please explain. / Yes No
14. Was the customer satisfied with the end product? If no, please explain. / Yes No
15. Has the firm being evaluated been provided an opportunity to discuss or respond to any negative comments or performance ratings? If so, what were the results? / Yes No N/A
16. Additional Remarks:
17. Overall rating for this firm: / E AA A B P
______
Signature of Evaluator Date
PLEASE NOTE: Contractors may be advised of adverse remarks and given the opportunity to respond in accordance with Federal Acquisition Regulation requirements.
Exhibit “B” – Past Performance Questionnaire - LDF, Page 3 of 3
(Rev 12/08)
EXHIBIT “B”
PAST PERFORMANCE QUESTIONNAIRE (PPQ) – OFFERORN62473-09-R-1610
Naval Facilities Engineering Command Southwest in San Diego, CA is considering the Offeror listed below. Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate commercial projects. If the referenced project is a government project, you may forward a copy of the official performance evaluation. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation (15.506) prohibits the release of the names of individuals providing reference information about an Offeror’s past performance. However, the solicitation requires the Past Performance Questionnaire (PPQ) be sent back to the contractor to be submitted in their proposal. So, to avoid having to fill out Past Performance Questionnaires for the same contractor/project numerous times, you may forward the questionnaire back to the contractor to be kept on file for any subsequent proposal submissions. If you do not want the contractor to have a copy of the completed PPQ, you may return it to this office by facsimile at
(619) 532-4789 prior to the proposal due date. In order to maintain the integrity of the source selection process, it is respectfully requested that you do not divulge the name of the Offeror, nor discuss your comments on this questionnaire with any other individuals.
Past Performance Information:
Name and Address of Offeror being evaluated:
Contract Number/Delivery or Task Order Number, Title, & Location:
Evaluator: (The following information will assist in the analysis of the data. Information will be kept confidential.)
Name of Evaluator:
Company/Agency Name:
Address:
Phone Number:
Position held or function in relation to project:
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. If the rating is Marginal or Unacceptable, please provide additional information in the appropriate block or in the remarks section of this form.
“O” / Outstanding / Performance greatly exceeded the contract requirements.
“A” / Above Average / Performance exceeded the contract requirements.
“S” / Satisfactory / Performance met the contract requirements.
“M” / Marginal / Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory.
“U” / Unacceptable / Performance was poor and/or did not satisfy contract requirements.
Please rate and provide any supporting information/comments for the following:
1. The relationship between the Offeror and client’s/customer’s contract team: / O A S M U
2. The Offeror’s management and coordination of subcontractors: / O A S M U
3. Overall corporate management, integrity, reasonableness, and cooperative conduct: / O A S M U
4. Quality of work: / O A S M U
5. Quality control: / O A S M U
6. Ability to meet the performance schedule: / O A S M U
7. Ability/actions to improve schedule problems, if applicable: / O A S M U
8. Ability to control costs and provide the required work at a reasonable total price: / O A S M U
9. Compliance with labor standards, as applicable: / O A S M U
10. Compliance with safety standards and/or number of safety related incidents, code compliance, as applicable: / O A S M U
11. Have any cure notices, show cause letters, letter of reprimand, suspension of payment, or termination been issued? If yes, please explain: / Yes No
12. Would you award another contract to the party being evaluated? If no, please explain. / Yes No
13. Was the customer satisfied with the end product? If no, please explain. / Yes No
14. Has the firm being evaluated been provided an opportunity to discuss or respond to any negative comments or performance ratings? If so, what were the results? / Yes No N/A
15. Additional Remarks:
16. Overall rating for this firm: / O A S M U
______
Signature of Evaluator Date
PLEASE NOTE: Contractors may be advised of adverse remarks and given the opportunity to respond in accordance with Federal Acquisition Regulation requirements.
Exhibit “B” – Past Performance Questionnaire - Offeror, Page 3 of 3
(Rev 12/08)
EXHIBIT “C”PAST PERFORMANCE - SMALL BUSINESS SUPPORT
N62473-09-R-1610
SUBCONTRACTING ACHIEVEMENT
Include actual dollar values subcontracted for each of the categories listed below.
1. Offeror Name:
Name of Joint Venture partner (if applicable):
2. Project No. (check one): - 1 - 2 - 3 - 4 - 5
3. Contract Number/Title:
Completion Date: ______
Total Contract Dollar Value: $ ______/ Whole Dollars / Percent of Total Subcontracted Value (c)
(a)Subcontracted to Small Business Concerns (Dollar amount and percent of line c)
FEDERAL: Including - SDB, WOSB, HBCU/MI, HUBZone, VOSB, and SDVOSB
NON-FEDERAL CERTIFICATIONS: Including - MBE (Minority Business Enterprise), DBE
(Disadvantaged Business Enterprise), DVBE (Disabled Veteran Business Enterprise),
SB (Small Business), and WBE (Women’s Business Enterprise)
(b) Subcontracted to Large Business Concerns (Dollar amount and percent of line c)
(c) Total Subcontracted Value (sum of lines a & b above)
(d) Small Disadvantaged Business Concerns (Dollar amount of line c)
Including MBE & DBE
(e) Women-Owned Small Business Concerns (Dollar amount of line c)
Including WBE
(f) HUBZone Small Business Concerns (Dollar amount of line c)
(g) Veteran-Owned Small Business Concerns (Dollar amount of line c)
(h) Service-Disabled Veteran-Owned Small Business Concerns (Dollar amount of line c)
Including DVBE
Name of customer reference for this project: ______
Phone Number: ______
Email address: ______
*NOTES:
- The Government acknowledges that the dollars in (d), (e), (f), (g), and (h) may NOT total to equal the “total subcontracted value” in line (c), as some small businesses may qualify for more than one small business category.
- In demonstrating their prior support for small business, Small Business Offerors may include for consideration contracts performed by themselves as small businesses, as well as subcontracts they may have awarded to other small businesses.
Exhibit “C” – Past Performance Small Business, Page 1 of 1
(Rev 6/09)
EXHIBIT “D”HISTORICAL SUPPORT FORSMALL BUSINESS
N62473-09-R-1610
All Offerors, including small businesses, shall fill in their firm’s corporate support to small business programs, including policies, outreach effort, in-house training, mentor-protégé program, assistance programs, conferences, support of Community Rehabilitation Programs, and use of organizations certified under JWOD by AbilityOne (formerly NIB/NISH).
CORPORATE SUPPORT:
1. Policies:
2. Outreach Effort:
3. In-House Training:
4. Mentor Protégé Program:
5. Assistance Programs (technical, development, and financial):
6. Conferences:
7. Support of Community Rehabilitation Programs and Use of Organizations Certified Under JWOD by AbilityOne:
8. Awards and/or certificates received within the five-year period for support provided to HUBZone, SB, SDB, WOSB, VOSB, SDVOSB firms, and, if applicable, HBCU/MI.*
*Following this Exhibit, provide legible copies or photos of all awards and/or certificates received within the five-year period. If a copy or photo of the small business award or certificate is not provided, the award or certificate will not be considered.
Note: Form may be expanded.
Exhibit “D” – Support for Small Business, Page2 of 2
(Rev 06/09)
EXHIBIT “E”SAFETY DATA SHEET
N62473-09-R-1610
This form is to be completed by the Offeror. Use this form to provide safety information for the Past Performance-Safety factor. Only complete year safety data will be considered. Partial year data will not be considered. If data is not available for an entire five-year period, the Offeror shall provide an explanation. If the data is not available from the insurance carrier, the Offeror shall provide a letter from the insurance carrier certifying that it is not available.
Joint Ventures: If the Offeror is a Joint Venture, one Exhibit “C” should be submitted for the Joint Venture. If there is no information for the Joint Venture, one Exhibit “C” should be submitted for each Joint Venture partner. Proposals that fail to submit information for all Joint Venture partners may be rated lower.
Joint Venture Offerors must also demonstrate the relationship between the Joint Venture partners and identify each partner's roles and responsibilities under the Offerors’ respective safety programs:
1. Offeror Name:
Name of Joint Venture partner (if applicable):
2. Offeror’s Most Recent Five (complete) Years of Reported Safety Data:
2008 / 2007 / 2006 / 2005 / 2004
Offeror’s Experience Modification Rate (EMR)
Offeror’s OSHA Lost Workday Incidence Rate (LWDIR)*
Offeror’s OSHA Recordable Incident Rate (RIR)**
Federal, State, and Municipal OSHA Citations Received by the Offeror
Number of Safety Awardsand/or Certificates Received by the Offeror***
NOTE:
*OSHA Lost Workday Incidence Rate (LWDIR) is based on the following industry standard calculation:
(200,000 x A)/B
Where A = the number of lost workday cases and B = total number of hours worked
**OSHA Recordable Incident Rate (RIR) is based on the following industry standard calculation:
(200,000 x C)/B
Where C = the number of recordable incidents and B = total number of hours worked
***Following this Exhibit, provide legible copies or photos of all safety awards and/or certificates received within the five-year period. If a copy or photo of the safety award or certificate is not provided, the award or certificate will not be considered.
3. Explanation of any incomplete safety data:
4. Explanation of all high rates received:
High Rate #1:
Type of rate (check one):
EMR LWDIR RIR
Year:
Description of the underlying incident:
Resultant time lost:
Corrective action taken: / High Rate #2:
Type of rate (check one):
EMR LWDIR RIR
Year:
Description of the underlying incident:
Resultant time lost:
Corrective action taken: / High Rate #3:
Type of rate (check one):
EMR LWDIR RIR
Year:
Description of the underlying incident:
Resultant time lost:
Corrective action taken:
5. Explanation of all citations received:
Citation #1:
Date of citation:
Description of the citation:
Resultant time lost:
Corrective action taken: / Citation #2:
Date of citation:
Description of the citation:
Resultant time lost:
Corrective action taken: / Citation #3:
Date of citation:
Description of the citation:
Resultant time lost:
Corrective action taken:
Citation #4:
Date of citation:
Description of the citation:
Resultant time lost:
Corrective action taken: / Citation #5:
Date of citation:
Description of the citation:
Resultant time lost:
Corrective action taken: / Citation #6:
Date of citation:
Description of the citation:
Resultant time lost:
Corrective action taken:
6. Offeror’s Insurance Carrier Information:
Insurance Carrier Name:
Name of Offeror’s Agent within the Insurance Agency:
Phone Number:
Note: Form may be expanded.