Exhibit A Past Performance Relevancy

FOR OFFICIAL USE ONLY

Modernize 6N Inpatient Restrooms (Swing for 3N)

EXHIBIT A

PERFORMANCE RELEVANCY SURVEY

Offeror Name/Company
PART 1. CONTRACT REFERENCES: Provide the following information requested in this format for each of the projects/contracts you intend to have considered for evaluation. Projects shall have been completed no more than 5 years prior to the solicitation issue date. Provide all information requested regarding YOUR PERFORMANCE on the contracts you elect to reference.
(NOTE: Offerors allowed NO MORE than 5 projects- offerors to make appropriate copies) Description of Effort as Prime (

) or Subcontractor (

)

Was project completed on time:

Yes (

)

No (

)

Any liquidated damages:
CPARS available:

Yes (

Yes (
) No

)

No
(

(

)
)

(NOTE: Offeror can provide CPARS with proposal; however, the questionnaire has more detailed questions.)
Provide detailed description of the work performed under the contract and describe why you believe the work is VERY REVELANT, RELEVANT, or SEMI-RELEVANT. (Circle one) 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.

Source Selection Information - See FAR 2.101 and 3.104

36C25626R0108 | Project No. 667-27-130

FOR OFFICIAL USE ONLY

Modernize 6N Inpatient Restrooms (Swing for 3N)
Relevance detailed description of project to include work by subcontractors:

Point of Contact of Reference on project (who you are sending questionnaire/survey to): Name:
Title:
Agency:
Email:
Phone:

POTENTIAL OFFERORS: IT IS YOUR RESPONSIBILITY TO FOLLOW-UP WITH YOUR

REFERENCES IN SUBMITTING QUESTIONNAIRES PRIOR TO THE CLOSE OF THE

SOLICITATION.
PART 2. NOT RELATED TO PART 1: Additional offeror information required, but not

project specific. THIS INFORMATION NEED ONLY BE PROVIDED ONCE IN YOUR

SUBMISSION PACKAGE.
Offeror representative providing the below information:

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

2.

Offerors are strongly encouraged to include with their proposals information on problems encountered on any relevant projects and the specific corrective actions taken to remedy