002 Form 1 Past Performance Quesionnaire.pdf

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):