Past perf questionnaire.pdf

Project Experience Questionnaire Attachment 1

1. Contractor Information

DUNs Number:

Firm Name:

Address:

Point of Contact:

Phone Number:

Email Address:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain)

Percent of project work performed:

If subcontractor, who was the prime (Name/Phone/Email:):

3.Contract Information

Contract Number: Delivery/Task Order Number (if applicable):

Contract Title:

Contract Location:

Award Date:

Contract Completion Date:

Contract Price:

4. Project Description: (Describe how this project is relevant to this requirement. Include details such as similar equipment, crews/personnel qualifications, requirements, conditions, etc. Attach additional pages if necessary.)

Part B: CLIENT INFORMATION (Client to complete questions 5-7 and page 2 of this Questionnaire)

5. Client Information Firm/Agency Name:

Name (individual completing this form):

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Client’s Signature: __________________________________ Date: __________________________________

Clients are encouraged to submit questionnaires directly to the quoter for submission to the Government.

However, questionnaires may be submitted directly to the Government POC (james.g.roloff@usda.gov). The Government reserves the right to verify any and all information on this form.

Part A: CONTRACT INFORMATION (Contractor to complete questions 1-4)

The quoter shall submit this Questionnaire for at least three (3) projects completed within the past five years to demonstrate relevant experience.

Relevant experience is defined as preventative maintenance services and repair services for the same or similar HVAC equipment. Make additional copies of this form as needed.

4.

Solicitation 12639520Q0071 apladraves Highlight apladraves Highlight apladraves Highlight apladraves Highlight

Project Experience Questionnaire (Part B continued)

RATING SCALE:

(E) Exceptional Performance met contractual requirements and exceeded many, to the Government/Owner’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

(VG) Very Good Performance met contractual requirements and exceeded some, to the Government's/Owner's benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

(S) Satisfactory Performance met minimum contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

(M) Marginal Performance did not meet some contractual requirements. The contractual performance reflected 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.

(U) Unsatisfactory Performance did not meet most contractual requirements and recovery was not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

(N) Not applicable No information or did not apply to your contract.

TO BE COMPLETED BY CLIENT: Using the definitions above, please circle the adjective rating which best reflects your evaluation of the contractor's performance.

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

1. Rate the contractor's compliance with contractual requirements.

2. Rate the contractor's ability to identify and correct non-compliance issues.

3. Rate the contractor's overall business relations.

4. Rate the contractor's overall conformance to schedule.

5. Rate the contractor's ability to provide a qualified workforce and equipment to this effort.

6. Rate the contractor's overall quality of service.

7. Rate the contractor's ability to manage and supervise personnel (includes management of subcontractors).

8. Ability to manage and supervise services performed at the work location.

9. Additional Remarks (attach additional pages if necessary):

5.