140R3021R0006_ATTACHMENT_5_Past_Performance_Questionnaire.pdf

SOURCE SELECTION SENSITIVE WHEN COMPLETED

***NOT TO BE RELEASED OUTSIDE GOVERNMENT CHANNELS***

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

U.S. Department of the Interior, Bureau of Reclamation, Boulder City, NV, is considering the firm listed below. Your comments would be appreciated regarding this firm’s past performance.

Past Performance Information:

Name and Address of Firm Being Evaluated:______________________________________

Contract No.:__________________ Type of Contract: _____________________ Project Title:___________________ Date of Award:_________________ Completion Date: _____________________ Location:______________________ Initial Amount:__________________ Final Amount: ________________________ Description:_________________________________________________________________

Evaluator: (The following information will assist in the analysis of the data.)

Name of Evaluator: ______________________________________

Company/Agency Name: ______________________________________

Address: ______________________________________

Phone Number: ______________________________________

Email Address: ______________________________________

Position Held or Function in Relation to Project: ______________________________________

Rating: If the rating is Marginal or Unacceptable, please provide additional information in the appropriate block or in the remarks section of this form.

“O” Outstanding Performance greatly exceeded the contract requirements.

“A” Above Average Performance exceeded the contract requirements.

“S” Satisfactory Performance met the contract requirements.

“M” Marginal Performance met the minimum contract requirements but

Some material aspects of the contractor’s performance were less than satisfactory.

“U” Unacceptable Performance was poor and/or did not satisfy contract requirements.

Solicitation No. 140R3021R0006 Land Management and Public Safety Services at Davis Dam

Please circle the appropriate rating and provide any supporting information/comments for the following:

1. The relationship between the firm and client’s/customer’s contract team: O A S M U

2. The firm’s management and coordination of subcontractors/consultants: O A S M U

3. Overall corporate management, integrity, reasonableness and cooperative conduct: O A S M U

4. Quality of work: O A S M U

5. Quality control: O A S M U

6. Ability to meet the performance schedule: O A S M U

7. Ability/actions to improve schedule problems, if applicable: O A S M U

8. Ability to control costs and provide the required work at a reasonable total price: O A S M U

9. Compliance with labor standards, as applicable: O A S M U

10. Compliance with safety standards and/or number of safety related incidents, code compliance, as applicable:

O A S M U

11. Did the contractor complete the project on time according to the contract performance period? Yes No

12. What was the size of the elevators in terms of speed and load?

Speed:

Load:

13. Have any cure notices, show cause letters, letter of reprimand, suspension of payment, or termination been issued? If yes, please explain: Yes No

14. Would you award another contract to the firm being evaluated? If no, please explain: Yes No

15. Was the customer satisfied with the end product? If no, please explain: Yes No

16. Has the firm being evaluated been provided an opportunity to discuss or respond to any negative comments or performance ratings? If so, what were the results? Yes No

17. Additional Remarks:

18. Overall rating for this firm: O A S M U

Print Name

Signature of Evaluator Date

Please submit completed questionnaire to the Bureau of Reclamation, Attention: Kathleen Berry, via email to kberry@usbr.gov mailto:gsteinau@usbr.gov