Attachment 3: Past Performance Questionnaire

General Contractor for the Seismic Retrofit at the Clemente Ruiz Nazario U.S. Courthouse, San Juan, Puerto Rico
Solicitation No. 47PB5126R0030

ATTACHMENT 3

PBS PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor/Offeror to complete Blocks 1-4)

1. CONTRACTOR/OFFEROR INFORMATION

Firm Name:
​
Address:
Phone Number:
DUNs Number:
Contact Name:
Email Address:

Contact Phone Number:

2. GENERAL WORK INFORMATION

Work performed as: ☐ Prime Contractor ☐ Subcontractor ☐ Joint Venture ☐ Other (Please explain): Percent (%) of project work performed:
If a 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 explain) Contract Title:
Contract Location:
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:

CUI//SP/SSEL/PROCURE

General Contractor for the Seismic Retrofit at the Clemente Ruiz Nazario U.S. Courthouse, San Juan, Puerto Rico
Solicitation No. 47PB5126R0030

ATTACHMENT 3

4. PROJECT DESCRIPTION

Complexity of Work: ☐ High ☐ Med ☐ Routine
How is this project relevant to the project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

INSTRUCTIONS FOR CLIENTS COMPLETING THIS QUESTIONNAIRE: PBS requests that the

client completes this questionnaire and submits it directly back to the offeror. The offeror will submit the completed questionnaire to PBS with their proposal, and may duplicate this questionnaire for future submission on PBS solicitations. Clients are highly encouraged to submit questionnaires directly to the offeror. However, questionnaires may be submitted directly to PBS. Please contact the offeror for PBS POC information. The government reserves the right to verify any and all information on this form.

Use the following adjective ratings and definitions in your evaluation of the Contractor’s performance.

RATING

DEFINITION

NOTE

(E)
Exceptional

Performance meets contractual
requirements and exceeds many to the
Government/Owner’s benefit. The
contractual performance of the element or
sub-element being assessed was
accomplished with few minor problems
for which corrective actions taken by the
contractor were highly effective.