Inactive Service-Disabled Veteran-Owned Small Business (SDVOSB) Set-Aside (FAR 19.14)

Sources Sought Notice Sources Sought Notice Page 23 of 23 Sources Sought Notice *= Required Field Sources Sought Notice Page 1 of 23 DESCRIPTIONS THIS ANNOUNCEMENT IS NOT A REQUEST FOR PROPOSAL. THE G... Sources Sought Notice Sources Sought Notice Page 23 of 23 Sources Sought Notice *= Required Field Sources Sought Notice Page 1 of 23 DESCRIPTIONS THIS ANNOUNCEMENT IS NOT A REQUEST FOR PROPOSAL. THE GOVERNMENT WILL NOT PAY NOR REIMBURSE ANY COSTS ASSOCIATED WITH RESPONDING TO THIS REQUEST. THE GOVERNMENT IS UNDER NO OBLIGATION TO AWARD A CONTRACT AS A RESULT OF THIS ANNOUNCEMENT The Department of Veterans Affairs is seeking a qualified Architect-Engineering (AE) firm to provide Design Development, Construction Documents, Technical Specifications, Construction Period Services, Site Visits, Cost Estimates, Shop Drawing Review, and all other related information for Project No. 630-23-108, DESIGN RENOVATE 12W CARDIAC STRESS LAB located at VA NEW YORK HARBOR HEALTHCARE SYSTEM, MANHATTAN CAMPUS, 423 East 23rd Street., New York, NY 10010. This procurement is restricted to Service-Disabled Veteran Owned Small Business (SDVOSB). All SDVOSBs must be visible/certified by the Office of Small and Disadvantaged Business Utilizations Center for Veterans Enterprise (CVE) through https://www.SBA.gov at time of submission of their qualifications in order to be considered for award. NOTE: Offerors are referred to VAAR 852.219-11(d)(1) Services. In the case of a contract for services (except construction), the contractor will not pay more than 50% of the amount paid by the government to it to firms that are not SBA-listed SDVOSBs as set forth in 852.219-10. In order to assure compliance with this clause, all firms submitting a SF330 for this Sources Sought Notice are required to indicate what percentage of the cost of contract performance will be expended by the concerns employees and in which discipline(s) and percentage of cost of contract performance to be expended (and in what disciplines) by any other subcontracted or otherwise used small or large business entity(s). Any subcontracted or otherwise business entity(s) used must be identified by name, office location and size/type of business (i.e., SDVOSB, VOSB, 8(a), large, etc). This is a Sources Sought Notice, and this requirement is being procured in accordance with the Brooks Act as implemented in FAR Subpart 36.6. Applicable NAICS code is 541330 and small business size standard of $22.5 Million. Magnitude of Construction is between $500,000.00 and $1,000,000.00. Potential contractors must be registered in SAM (www.sam.gov) at time of submission of their qualifications to be considered for an award. The design will be completed in a manner such that the estimated construction cost is within the VA budget. It is not expected that any new space will be added to the existing building footprint. 852.219-10 VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS SET-ASIDE (JUL 2016) (DEVIATION) SCOPE OF SERVICE REQUIRED: The general scope of this project is to provide A/E professional services to include all labor, materials, equipment, and supervision necessary to design and construct 12 West Cardiac Stress Lab. All work shall be performed at the Veteran s Affairs Medical Center, 423 East 23rd Street, New York, New York for Y 10010 for the following items, but not limited to: Convert existing storage room to new office (148 SF). Construct a new waiting area (15 SF). Construct a new wall and entrance door. Convert Cardiac Nurse room to ECHO room (175 SF). Add small back-to-back hand wash sinks. Construct a small curtain changing area inside the existing Stress Test Exam room. Replace existing ceiling and floor tiles in the Hallway, Hot Lab (Was Nuclear Medicine storage) and Stress Test Exam room with new to match existing or better tiles. Paint all existing walls in the Hallway and Stress Test Exam room. Oversee a pre-design test, adjust, balance (TAB) of the existing air distribution system (s) serving the 12 West Cardiac Stress Lab suite. Provide three (3) Construction Period Services Site Visits. All designs shall comply with applicable sections of VA publications, Planning Criteria for Medical Facilities , H-08-09; and Equipment Guide List , H-08-5: Also, NFPA, OSHA, ANSI, JCAHO, VA standards and other applicable Federal, State and local code requirements, including UBC. A/E shall be responsible for complete functional design and provide bid documents meeting all the requirements. Ownership of the Construction Criteria Base (CCB) software is required. Provision of the text of specifications named in the construction specifications by reference shall be performed by the A/E as part of this contract. Applicable chapters of VA Master Construction Specifications shall be prepared by the A/E, including any necessary adaptations. VA Construction Standards, H-08-3, shall apply to specific design requirements. Particular attention is called to CD4, Symbol Identification of Contract Drawings , and CD5, Contract Drawings Details . Equipment symbols shall be utilized to the greatest extent practicable. The A/E shall carefully review all requirements of the latest edition of the Accreditation Manual for Hospitals of the Joint Commission of Accreditation of Hospitals, with respect to design and operating requirements and report all conflicting conditions in writing. Designs for the accommodations of the physically handicapped shall conform to VA H-08-13, Barrier Free Design Handbook and VA Construction Standard CD-28, Accommodation for the Physically Handicapped COST RANGE Estimated Construction Cost Range: $500,000.00 and $1,000,000.00 TYPE OF CONTRACT CONTEMPLATED The Department of Veterans Affairs is contemplating awarding a firm fixed price contract. The following evaluation criteria will be used during the A/E selection process with assigned value: Firms submitting SF330 data for consideration must address each of the following factors in SF330. Professional qualifications necessary for satisfactory performance of required services -20%. Offerors will be evaluated in terms of the qualifications, competence and experience of the key personnel and technical team proposed to accomplish this work. Key personnel are individuals who will have major contract or project management responsibilities and/or will provide unusual or unique expertise. Provide a balanced licensed and or certified workforce in the following disciplines Engineering (Civil, Structural, Mechanical, Electrical, Interior Design, Fire Protection) and Architecture Submission requirements: Provide resumes for all proposed key personnel. Resumes are limited to one page each and should cite project specific experience and indicate proposed role in this contract. Provide professional registration, certification, licensure and/or accreditation. Indicate participation of key personnel in example projects in the SF-330 Part 1 Section G. Specialized experience and technical competence in the type of work required, including, where appropriate, experience in energy conservation, pollution prevention, waste reduction, and the use of recovered materials -20%. Offerors will be evaluated on specialized experience and technical competence in the performance of services similar to those anticipated under this contract with regard to: Experience with design services to renovate and redesign patient facilities and medical centers. Experience in providing post construction award services (shop drawing review, as-built drawing and Quality Assurance Plan (QAP) preparation and construction inspection services) :Experience in construction period services to include professional field inspections during the construction period, review of construction submittals, support in answering requests for information during the construction period, and support of construction contract changes to include drafting statements of work, and cost estimates Submission requirements: Provide up to five (5) projects completed or substantially completed within the past five (5) years that best illustrate specialized experience of the proposed team including any subcontractors in the areas outlined above. (3) Capacity to accomplish the work in the required time-15%. This factor evaluates the ability of the firm, given their current projected workload and the availability of their key personnel, to accomplish the possible myriad of design projects in the required time. Submission requirements: The general workload and staffing capacity of the design office will be evaluated. List current projects with a design fee of greater than $20,000 being designed in the firms office. ii. Indicate the firms present workload and the availability of the project team (including sub-consultants) for the specified contract performance period; Describe experience in successfully delivering projects per performance schedule, providing timely construction support, and successfully completing multiple projects with similar delivery dates. The firm shall provide a project schedule that demonstrates the understanding of the project scope, restrictions which must be considered in the schedule, understanding of events associated with coordinating design submittals and incorporating review comments, and the capability to schedule the complete design effort within the proposed contract duration. (4) Past performance- 15%. Offerors will be evaluated on past performance with Government agencies (emphasis on VA work) and private industry in terms of work quality, compliance with schedules, cost control, and stakeholder/customer satisfaction. Recent is defined as performance occurring within 5 years of the date of this Sources Sought, except that ongoing projects must have begun no less than one (1) year prior to the issuance of this Sources Sought. Relevancy is defined as performance of work on projects that are similar in scope to the types of projects anticipated under the resultant contracts. Respondents with no previous past performance shall state this when addressing the selection criteria. Where there is no record of past performance, the proposal will be evaluated neither favorably nor unfavorably. Superior performance ratings on relevant projects may be considered more favorably in the evaluation. Submission Requirements: i. Submit a minimal of three (3) references; any of the following evaluations are acceptable: a. Contractor Performance Assessment Report System (CPARS), b. Past Performance Questionnaire (PPQ) evaluation for each project submitted under Criterion 2. ii. If a completed CPARS evaluation is available, it shall be submitted with the completed SF330 package. If there is not a completed ACASS/CPARS evaluation, the PPQ included with this notice (Attachment #1) is provided for the Offeror or its team members to submit for each project included in criterion (2). If a PPQ is submitted, but an official ACASS/CPARS evaluation is found for that project in government databases, the official evaluation will take precedence. If an ACASS/CPARS evaluation is not available, ensure correct phone numbers and email addresses are provided for each contract customer/reference. If the A-E is unable to obtain a completed PPQ from a contract customer/reference for a project before the response date set forth in this notice, the A-E should complete and submit with their response the first page of the PPQ (Attachment #1), including contract and point of contact information for the respective projects. iii. A-Es should follow-up with references to ensure timely submittal of questionnaires. At the reference s request, questionnaires may be submitted directly to the Governments point of contact, Samantha Chavanga via email at Samantha.Chavanga@va.gov, prior to the response date. A-Es shall not incorporate by references into their response CPARS or PPQ evaluations previously submitted in response to other A-E services procurements. However, this does not preclude the Government from utilizing previously submitted PPQ information in the past performance evaluation. Submitted CPARS and PPQ evaluations will not be counted as part of any page limitation and shall be attached to the SF330, behind the SF330 Part II document (5) Location -10% within a 300-mile radius to the design site (Manhattan, NY) and knowledge of the location (Manhattan VAMC, NY); provided that the application of this criterion leaves an appropriate number of qualified firms, given the nature and size of the contract, firms/teams will be evaluated on the locations of their office or offices that will be performing the work under this contract. Submission requirements: i. The A/E Firm proximity to the NY Harbor Healthcare System, Manhattan VAMC, 423 East 23rd Street, New York, NY 10010. ii. This distance is determined according to http://maps.google.com/ iii. This factor evaluates the distance the AE firm's design office or offices from the location of work. Please provide the address (es) and distance of your closest office to the address listed (6) Record of significant claims against the firm because of improper or incomplete architectural and engineering services-10%. Offerors with substantiated claims against the firm as a result of improper architectural and engineering services provided in the last three (3) years. Submission requirements: Records and any other documentation of substantiated claims highlighting improper or incomplete architectural engineering services against the firm within the last three (3) years. The SF-330 shall contain a statement affirming that there are no records of significant claims because of improper or incomplete architectural and engineering services. (7) Specific experience and qualifications of personnel proposed for assignment to the project and their record of working together as a team- 10%. Submission requirements: Offerors shall submit evidence of individuals experience and qualifications in their respective fields. Additionally, documentation must be provided to show these individuals have worked together as a team on previous projects and their role. (Completing Sections E, F, and G, on the SF-330 meets the documentation requirement). Furthermore, offerors shall describe the ability of the firm to manage, coordinate and work effectively with team members, both internal staff and consultants. Discuss the history of working relationships with team members, including joint venture partners where applicable Evaluation Scoring Evaluation factors will be evaluated using the following adjectival ratings as follows: Outstanding: Proposal meets requirements and indicates an exceptional approach and understanding of the requirements. Strengths far outweigh any weaknesses. Risk of unsuccessful performance is very low. Good: Proposal meets requirements and indicates a thorough approach and understanding of the requirements. Proposal contains strengths which outweigh any weaknesses. Risk of unsuccessful performance is low. Acceptable: Proposal meets requirements and indicates an adequate approach and understanding of the requirements. Strengths and weaknesses are offsetting or will have little or no impact on contract performance. Risk of unsuccessful performance is moderate. Marginal: Proposal does not clearly meet requirements and has not demonstrated an adequate approach and understanding of the requirements. The proposal has one or more weaknesses which are not offset by strengths. Risk of unsuccessful performance is high. Unacceptable: Proposal does not meet requirements and contains one or more deficiencies. Proposal is not awardable. The firm s proposal demonstrates a misunderstanding of the requirement, and the approach fails to meet performance standards. The firm s proposal has major omissions and inadequate details to assure evaluators that the offeror has an understanding of requirement. The ratings identified below were used in the evaluation of Past Performance (Criterion 4): Substantial Confidence: Based on the offeror s recent/relevant performance record, the Government has a high expectation that the offeror will successfully perform the required effort. No doubt exists based on the offeror s past performance that they can satisfy the requirements of the contract. Satisfactory Confidence: Based on the offeror s recent/relevant performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort. Little doubt exists based on the offeror s past performance that they could satisfy the requirements of the contract. Unknown Confidence (Neutral): No recent/relevant performance record is available, or the offeror s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned. Limited Confidence: Based on the offeror s recent/relevant performance record, the Government has little expectation that the offeror will be able to successfully perform the required effort. Some doubt exists based on past performance that they could satisfy the terms and conditions of the contract. No Confidence: Based on the offeror s recent/relevant performance record, the Government has little expectations that the offeror will be able to successfully perform the required effort. Significant doubt exists based on the offeror s past performance that they can satisfy the requirements of the contract. SELECTION INTERVIEW: Interviews shall be scheduled with firms slated as the most highly qualified. Firms slated for interviews may be asked to explain or expand on information contained in the SF-330 submittal through a formal interview or a discussion questionnaire as determined by the Contracting Officer. ESTIMATED START AND COMPLETION DATES SP-13 DESIGN REVIEW AND COMPLETION SCHEDULE The A/E shall perform the work required within the limits of the following schedule. A/E shall provide professional architects and engineers as directed by the Contracting Officer who are familiar with the work to attend the Design reviews on the following dates: Submit 100% Preliminary Documents for VA review .30 calendar days from NTP Review 100% Preliminary Documents with VA Personnel .45 calendar days from NTPÂ Submit 65% Construction Documents for VA review .....60 calendar days from NTPÂ Review 65% Construction Documents with VA Personnel .75 calendar days from NTPÂ Submit 100% Construction Documents for VA review ...90 calendar days from NTPÂ Review 100% Construction Documents with VA Personnel ..110 calendar days from NTPÂ Deliver Construction Bid Documents for Construction ..120 calendar days from NTP Total number of days for entire design is 120 calendar days from Notice to Proceed. NOTE: The Consultant is responsible for the development of a project estimate. The project estimate shall be all inclusive (construction, engineering, legal, administrative, etc). The Consultant shall advise the Contracting Officer in writing if at any time the cost of the project is perceived to exceed the established budget. The Consultant will notify the Contracting Officer at the time it is recognized, not after the fact. SUBMISSION REQUIREMENTS The applicable NAICS code is 541330 and the small business size is $22.5 Million. This acquisition for design services will be a 100% set aside for service-disabled veteran owned small business concern (SDVOSB). All SDVOSBs must be verified by the Office of Small and Disadvantaged Business Utilizations Center for Veterans Enterprise (CVE) through www.vetbiz.gov before award. SDVOSB firms desiring consideration must have a working office located within 300 miles of the Manhattan, New York City limits and be licensed in New York State. All interested SDVOSB A/E firms are invited to submit Standard Form 330, Architect Engineer Qualifications and for any consultants, on SF 330 Extra Sections E and F. Standard form 330 can be obtained at the following web site: http://www.gsa.gov/portal/forms/download/21DBF5BF7E860FC185256E13005C6AA6. Qualified Service-Disabled Veteran Owned Small Business (SDVOSB) firms responses must be received no later than 4:00 PM, EST on Thursday, 10/20/2022. Electronic submission of SF330 s is preferred. The overall size of the file cannot exceed 7MB; if additional space is required, divide the file into segments with each file size less than 7MB. No more than 2 files at 7MB each will be considered. Email completed SF330 s to Samantha.Chavanga@va.gov Subject Line: Design Renovate 12W Cardiac Stress Lab, 36C24223R0101 SF330. NONCOMPLIANCE WITH THIS REQUIREMENT RISKS YOUR PACKAGES AS BEING NONRESPONSIVE NOTE: Any request for assistance with submission or other procedural matters shall be submitted via email only (Samantha.Chavanga@va.gov); telephone inquiries will not be honored. THIS ANNOUNCEMENT IS NOT A REQUEST FOR PROPOSAL. THE GOVERNMENT WILL NOT PAY NOR REIMBURSE ANY COSTS ASSOCIATED WITH RESPONDING TO THIS REQUEST. THE GOVERNMENT IS UNDER NO OBLIGATION TO AWARD A CONTRACT AS A RESULT OF THIS ANNOUNCEMENT. PAST PERFORMANCE QUESTIONNAIRE Solicitation Number: 36C24223R0101 Project Title: AE Design Renovate 12W Cardiac Stress Lab Project #630-23-108 CONTRACT INFORMATION (Contractor to complete Blocks 1-4) 1. Contractor Information Firm Name: CAGE Code: Address: DUNs Number: Phone Number: Email Address: Point of Contact: Contact Phone 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: 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: 4. Project Description: Complexity of Work High Med Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.) CLIENT INFORMATION (Client to complete Blocks 5-8) 5. Client Information Name: Title: Phone Number: Email Address: 6. Describe the client s role in the project: 7. Date Questionnaire was completed (mm/dd/yy): 8. Client s Signature: Section D: Performance Information: Choose the letter on the scale that most accurately describes the contractor s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY UNSATISFACTORY OR MARGINAL RATINGS. E VG S M U N Exceptional (Outstanding) Very Good (Above Average) Satisfactory Marginal Unsatisfactory Not Available Performance meets contractual requirements and exceeds many to the Government s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective Performance meets contractual requirements and exceeds some to the Government s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the Contractor were effective Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the Contractor appear, or were, satisfactory. Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the Contractor has not yet identified corrective actions. The Contractor s proposed actions appear only marginally effective, or were not fully implemented Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the Contractor s corrective actions appear or were ineffective No record of past performance or the record is inconclusive. 1. QUALITY: a) Quality of technical data/report preparation efforts E VG S M U N a.1. Comments: b) Ability to meet quality standards specified for technical performance E VG S M U N b.1. Comments: c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance E VG S M U N c.1. Comments: d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance) E VG S M U N d.1. Comments: 2. SCHEDULE/TIMELINESS OF PERFORMANCE: a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below) E VG S M U N 2.a.1 Comments: b) Rate the contractor s use of available resources to accomplish tasks identified in the contract E VG S M U N 2.b.1. Comments: 3. CUSTOMER SATISFACTION: a) To what extent were the end users satisfied with the project? E VG S M U N 3. a.1. Comments: b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication) E VG S M U N 3.b.1. Comments: c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer? E VG S M U N 3.c.1. Comments: d) Overall customer satisfaction E VG S M U N 3.d.1 Comments: 4. MANAGEMENT/ PERSONNEL/LABOR a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force? E VG S M U N 4.a.1. Comments: b) Ability to hire, apply, and retain a qualified workforce to this effort E VG S M U N 4.b.1 Comments: c) Government Property Control E VG S M U N 4.c.1. Comments: d) Knowledge/expertise demonstrated by contractor personnel E VG S M U N 4.d.1. Comments: e) Utilization of Small Business concerns E VG S M U N 4.e.1. Comments: f) Ability to simultaneously manage multiple projects with multiple disciplines E VG S M U N 4.f.1. Comments: g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes E VG S M U N 4.g.1. Comments: h) Effectiveness of overall management (including ability to effectively lead, manage and control the program) E VG S M U N 4.h.1. Comments: 5. COST/FINANCIAL MANAGEMENT a) Ability to meet the terms and conditions within the contractually agreed price(s)? E VG S M U N 5.a.1. Comments: b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client E VG S M U N 5.b.1. Comments: c) If this is/was a Government cost type contract, please rate the Contractor s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns) E VG S M U N 5.c.1. Comments: d) Is the Contractor s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section. Yes No 5.d.1. Comments: e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below. Yes No 5.e.1. Comments: f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below. Yes No 5.f.1 Comments: 6. SAFETY/SECURITY a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.) E VG S M U N 6.a.1 Comments: b) Contractor complied with all security requirements for the project and personnel security requirements. E VG S M U N 6.b.1. Comments: 7. GENERAL a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues). E VG S M U N 7.a.1. Comments: b) Compliance with contractual terms/provisions (explain if specific issues) E VG S M U N 7.b.1. Comments: c) Would you hire or work with this firm again? (If no, please explain below) Yes No 7.c.1. Comments: d) In summary, provide an overall rating for the work performed by this contractor. E VG S M U N 7.d.1. Comments: Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ STRENGTHS:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ WEAKNESSES:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DEFICIENCIES:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ COMMENTS:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Past Performance Information provided by: __________________________________________________ (Printed Name) Signature________________________________________Date:_________________ Organization:____________________________________Phone:_________________ Â Â