04 Attachment Past Performance Questionnaire.pdf

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

SECTION A: Contractor Information

A. Contractor’s name and address: __ _________________________________________

B. Point of Contact: _____________________________

C. Phone Number (with area code): _________ __________

D. Contract number: ________________________________________

E. Project Title or Description of Work performed under this project: ___ _______________________________

G. Contract Award Date: Scheduled Completion Date: _____________________________

H. Contract Award Amount: Current/Final Project Amount: ____________________

SECTION B: RESPONDENT INFORMATION

EVALUATED BY:

(Signature) (Date)

______________________ Address: _______________________________ (Title)

NOTE: The identity of individual(s) providing the reference information shall not be disclosed.

Source Selection Sensitive

N NOT APPLICABLE – Unable to provide a score. Performance in this area not applicable.

The contractor:

1 How efficient was the contractor in abiding by all Rules, Regulations, Laws, and Safety Standards?

2 Were you satisfied with the quality of service performed or items supplied?

3 How effective were the contractor’s quality control and/or inspection procedures?

4 How well did the contractor perform in a respect to timeliness and schedule?

5 How well did the contractor resolve Issues/

Problems/Customer Complaints?

6 How flexible, cooperative, reasonable was the contractor, particularly when faced with short‐notice mission changes or requirements changes?

8 How likely are you to award another contract to this contractor?

ADDITIONAL REMARKS:

**Please forward this questionnaire directly to the USPFO of Arizona **

E‐MAIL: sabreana.m.williams.civ@army.mil Subject: W912L223Q0001 PPQ and ng.az.azarng.list.az-purchasing-and-contracting@army.mil

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