Past_Performance_Questionnaire_Firms_Customers.doc

140F0918Q0051

FISH AND WILDLIFE SERVICE

PRESENT AND PAST PERFORMANCE QUESTIONAIRE

This is to be sent to 2 customers

The solicitation requires the firm to provide a list of recent and relevant projects and for the firm to submit a Past Performance Questionnaire to the listed references as it relates to this proposed agreement. It is IMPORTANT to note that the reference must re-submit the completed questionnaire directly to the Contracting Officer and not to your company. The questionnaire must be submitted to the Contracting Officer by the due date. The contact information for the Contracting Officer is as follows. The questionnaire may be submitted by either means:

NOTE: The failure of the firm to provide, and request their references to submit the past performance questionnaire to the Contracting Officer may render the firm’s quote non responsive.

A. EMAIL or FAX COMPLETED SURVEY/QUESTIONNAIRE TO:

U.S. Fish and Wildlife Service, Cathleen DeBerry, 303-236-4791.

Cathleen_deberry@fws.gov B. GENERAL Information: Please correct any information below known to be inaccurate:

Contractor’s Name

Address

Telephone Number

Fax Number

Contractor’s Contact

1. Project Title or Brief Description of Work:

2. Contract Number Provided by Offeror: __________________________

3. Dollar Amount:____________________________________

4. Contract Period or Dates of Performance Provided by Offeror:_________________

5. Contractor performed as the ___Prime Contractor ____Sub-Contractor ____ Key Personnel.

C. Respondent Information:

D. Performance Information: By placing an “X” below, choose the number on the scale of 0 to 6 that most accurately describes the contractor’s performance or situation. Please provide a Narrative Explanation for any Ratings of 0, 1, or 2.

1. Quality of Product or Service

Agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards containing similar requirements.

requirements.

requirements.

requirements.

performance requirements without commensurate additional costs to the Government.

of anticipated achievements and is commendable as an example for others, so that it justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

RATING: _0=Unsatisfactory _1=Poor _2=Fair X_3=Good _4=Excellent _5=Outstanding

Comments for Quality of Product or Service:

2.

Cost Control (Rating and Comments for Cost Control are not required if contract type is Fixed-Price)

Agency resources. Recovery is not likely. If performance cannot be substantially corrected, this level of ability to manage cost issues constitutes a significant impediment in consideration for future awards.

contract requirements.

requirements.

requirements.

achieving cost savings to the Government.

the score. It is expected that this rating will be used in those rare circumstances where the contractor achieved cost savings and performance clearly exceeds the performance levels described as "Excellent".

RATING: _0=Unsatisfactory

_2=Fair _3=Good _X 4=Excellent 5=Outstanding

Comments for Cost Control:

3.

Timeliness of Performance

resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards.

to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

RATING: _0=Unsatisfactory

_2=Fair _3=Good X_4=Excellent

Comments for Timeliness of Performance:

4.

Business Relations

substantially mitigated or corrected it should constitute a significant impediment in onsiderations for future awards.

expectation.

the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

RATING: _0=Unsatisfactory

_2=Fair _3=Good _X4=Excellent

Comments for Business Relations:

Additional Info

Subcontracts

Are subcontracts involved?

__Yes _ No (Check one)

Comment on subcontracts:

Contractor Key Personnel

Contractor Manager/Principal (name): ____ _____________________________ Comment on Contractor Manager/Principal:

Contractor Key Person (name): ___

Comment on Contractor Key Person:

Contractor Key Person (name): ________________________________________________ Comment on Contractor Key Person:

Customer Satisfaction

Is/was the contractor committed to customer satisfaction?

_ Yes _No (Check one)

Would you recommend the selection of this firm again?

_Yes _No (Check one)

Comments on Customer Satisfaction:

When Filled In This Document Is Source Selection Sensitive Information IAW FAR 2.101 and 3.104