002_Form_1___Past_Performance_Quesionnaire_1_page.pdf

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Attached to
REPAIR AND PAINT EXTERIOR OF BUXTON DKQ
Solicitation number
140P5323R0040
Issued by

About this file

This document contains a past performance questionnaire for a federal contractor. The questionnaire requests information about a contractor's past performance on an unspecified contract, including the contract number, dates, value, type, description of requirements, and evaluator ratings and comments on quality, performance, technical requirements, schedule, cost control, customer satisfaction, and overall assessment. The related federal contract opportunity is solicitation number 140P5323R0040 from the Department of the Interior National Park Service Southeast Region to repair and paint the exterior of the Buxton DKQ building. Responses to the past performance questionnaire are requested by a certain date to support a source selection for an unnamed project.

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PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this questionnaire and email to: (insert email) Desired Response Date: (insert response date)

When complete, the information in this form is SOURCE SELECTION INFORMATION (FAR 2.101 & 3.104 and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

1. CONTRACTOR NAME & ADDRESS:

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

Pease add a continuation page if additional space is necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR’S NAME, POSITION (Project Manager/COR/Other) AND ORGANIZATION:

b. EVALUATOR’S PHONE NO: c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

Please circle the response code for each topic (A-G) that best reflects your experience with this contractor.

EX = Exceptional S = Satisfactory US = Unsatisfactory

VG = Very Good MG = Marginal N/O = Not Observed

A. Quality of Products and Services – Assess the contractor’s conformance to contract requirements, specification, and standards of good workmanship (e.g. technical, professional, environmental, or safety and health standards). EX VG S MG US N/O

B. Performance – Assess the contractor’s performance as the General Contractor or A/E (as appropriate) for the project. EX VG S MG US N/O

C. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract. EX VG S MG US N/O

D. Schedule – Assess the timeliness of contractor against the schedule of activities.

EX VG S MG US N/O

E. Cost Control – Assess the contractor’s ability to manage the contract budge and control costs.

EX VG S MG US N/O

F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and user

“friendliness”. EX VG S MG US N/O

G. Overall Assessment. EX VG S MG US N/O

2. CONTRACT NO:

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options):

6. TYPE OF CONTRACT (Fixed Price, FPI, etc.):

1a: NAME OF PRIME CONTRACTOR (if this questionnaire is for a team member on the SRI Ranch House project):

File details come from the government source that posted it. Updated .