123C7818Q0002_-_PPQ.pdf

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION

APPENDIX A

PAST PERFORMANCE QUESTIONNAIRE

TITLE / ABSTRACT SERVICES, State of Kansas United States Department of Agriculture (USDA) Natural Resources Conservation Services (NRCS)

123C7818Q0002

Name of Contractor:

Contract Information

Name of Reference Organization:

Contract No:

Contact Title:

Contract Value:

Type of Contract:

Period of Performance:

The ratings below are supplied by the reference identified above, NOT the contractor.

Performance Elements Excellent Good Satisfactory Marginal Unsatisfactory Not

Applicable

1. Quality of Product or Service

2. Timeliness of Performance

3. Effectiveness of Management (including subcontractors)

4. Response to Technical Direction

5. Responsiveness to Performance Problems

6. Overall Performance

1. Remarks on excellent performance: (Provide data supporting this observation. You may continue on a separate sheet if needed.)

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SOURCE SELECTION INFORMATION

2. Remarks on unsatisfactory performance: (Provide data supporting this observation. You may continue on a separate sheet if needed.)

3. Please identify any corporate affiliations with the contractor.

4. Would you do business with again? YES NO (Insert contractor’s name) (Circle one)

5. Information provided by:

Name Mailing address (Street and P.O. Box)

Title City, State and Zip Code

Time of Call Telephone and Fax Numbers

6. Questionnaire completed by:

Date Signature and Title of COE Employee

Please email the completed Questionnaire to:

Ryan Lorimer Contract Specialist USDA- NRCS CSB Team 3 800 W. Evergreen Ave, Suite 100 Palmer, AK 99645 Phone: 907-761-7744 Email: ryan.lorimer@wdc.usda.gov mailto:steven.alves@wdc.usda.gov