12_Attach_B_Past_Perform_Question_PVU_Well.docx

ATTACHMENT B: PAST PERFORMANCE QUESTIONNAIRE

Solicitation # 140R4018R0010: Paradox Valley Unit 2nd Well Design

Your assistance is requested in support of a source selection. The minimum requirement is three (3) sources that must be received by the Acquisition Management Division no later than the date below.

Responses Due Date: June 6, 2018 Please complete this Questionnaire mail or email to:

U.S. Department of Interior - Bureau of Reclamation Attn: Dan Hays (UC-841) 125 South State Street, Room 8100 Salt Lake City, UT 84138-1147 email: dhays@usbr.gov - Phone: (801) 524-3757

TO BE COMPLETED BY OFFEROR

1. CONTRACTOR NAME:

ADDRESS:

CITY/ZIP:

1a: NAME OF PRIME CONTRACTOR:

2. CONTRACT NO.:

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

6. TYPE OF CONTRACT (Fixed Firm Price, CMP, FPI, etc.):

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

b. Organization Name:

c. Evaluator's Phone Number:

d. Evaluator’s email:

e. Months Performance Monitored by Evaluator:

*** See page 2 of 2 for additional questions ***

Please check the response for each topic (A-G) that best reflects your experience with this contractor.

A. Quality of Products and Services - Assess the contractor's conformance to contract requirements, specifications and standards of good workmanship (e.g., technical, professional, environmental or health and safety standards.

☐ Neutral ☐ Outstanding ☐ Better ☐ Satisfactory ☐ Marginal

B. Performance - Assess the contractor's performance as the General Contractor or Architect/Engineer (as appropriate) for the project.

☐ Neutral ☐ Outstanding ☐ Better ☐ Satisfactory ☐ Marginal

C. Technical Requirements - Assess the contractor's ability to fulfill the technical requirements of the contract.

☐ Neutral ☐ Outstanding ☐ Better ☐ Satisfactory ☐ Marginal

D. Schedule - Assess the timeliness of the contractor against the schedule of activities.

☐ Neutral ☐ Outstanding ☐ Better ☐ Satisfactory ☐ Marginal

E. Cost Control - Assess the contractor's ability to manage the contract budget and control costs.

☐ Neutral ☐ Outstanding ☐ Better ☐ Satisfactory ☐ Marginal

F. Customer Satisfaction - Assess the contractor's responsiveness to customer concerns and "user friendliness".

☐ Neutral ☐ Outstanding ☐ Better ☐ Satisfactory ☐ Marginal

G. Overall Assessment

☐ Neutral ☐ Outstanding ☐ Better ☐ Satisfactory ☐ Marginal

Additional Comments: