PAST_PERFORMANCE_SURVEY.pdf

PAST PERFORMANCE SURVEY

17-102-SOL-00013: Ft. Thompson Crow Creek Sioux Reservation Primary Wastewater Lagoon Cell

Renovation

INSTRUCTIONS: This form is to document past performance for projects relevant and similar requirements stated in the solicitation.

Offeror/Contractor: Please complete Part 1 and provide each reference/evaluator with the form.

Reference/Evaluator: Please complete Part 2 and provide your candid responses. The information you provide will be used in the evaluation of the offeror/contractor for potential award of a federal contract or agreement; therefore important that your information is factual, accurate, and complete as possible. If you do not have knowledge of or experience with the company in question, please forward to the person who does.

Please submit the completed survey by mail, fax, or email prior to 2:00 PM (Pacific) on March 13, 2017

IHS DES-Seattle email: Anthony.buch@ihs.gov Attn: Anthony Buch 701 5th Ave, Suite 1600 Seattle, WA 98104

PART 1: (TO BE COMPLETED BY THE OFFEROR/CONTRACTOR)

A. NAME OF COMPANY BEING

EVALUATED:

B. NAME/ADDRESS OF

COMPANY PROVIDING

EVALUATION INFORMATION:

Company Name:

Evaluator's Name and Title:

Address:

Telephone No.: E-mail Address:

C. PROJECT INFORMATION

(Under Work Description, include similarities/relevance to solicitation project AND a description of work performed to include specific requirements, location, and complexity.)

Contract No.:

Date of Award:

Project Title/Location:

Work Description:

Contract Type:

Original Contract Price:

Final Contract Price:

Original Completion Date:

Forecasted/Actual Completion Date:

Work was with: Commercial ____ Fed. Gov't ____ Local/City/State Gov't ____

PART 2: EVALUATION (INFORMATION TO BE COMPLETED BY THE EVAULATOR RESPONDING FOR THE OFFEROR):

For each performance element identified below, references should evaluate performance of the firm or individual identified in Part 1 of this form. Where the reference lacks sufficient information to provide an evaluation for a particular performance element, this should be noted. Where any deficiency or unfavorable information is identified, the reference should identify any mitigating factors that may weigh in favor for the person/firm on whose behalf the reference is provided (i.e., problems due to causes outside the contractor's control). An individual within your organization that is knowledgeable of the contractor's day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor's (offeror's) performance with the judgment of others within their organization, as applicable.

The following chart depicts the ratings that are to be used to evaluate the contractor's performance:

E VG S M U

Exceptional Very Good Satisfactory Marginal Unsatisfactory

The offeror provided exceptional performance in the area being evaluated and there were no weaknesses or deficiencies identified.

The offeror has a very good performance record in the area being evaluated. Only minor weaknesses or deficiencies were

The offeror’s performance was satisfactory but not otherwise exemplary.

Weaknesses or deficiencies were identified in their performance.

The offeror has a marginal performance record and one or two significant weaknesses or deficiencies were

The offeror has a poor performance record.

Several significant weaknesses or deficiencies were identified, which lead to a material failure in meeting the contract terms and conditions.

When responding to the questions listed, circle or highlight the letter that most accurately describes the contractor's performance or situation. For any Exceptional, Marginal or Unsatisfactory rating assessed by the customer on individual elements or overall rating assigned on the past performance questionnaire, shall include an explanatory narrative to be provided in the remarks block.

These narratives need not be lengthy, just adequate to support evidence of the specific ratings noted above. Failure to provide information supporting the assigned rating may result in a lower rating being designated than that assigned by the Evaluator. If a question is not applicable, please indicate as such. If you circle a Yes or No answer that is marked with an asterisk (*), please provide a corresponding explanation in the remarks block. If more space is required, use the back of the questionnaire or attach additional pages. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legible. Your time and effort in providing this information is vitally important and is greatly appreciated.

QUALITY OF SERVICE

1. Contractor's compliance with contractual terms and conditions. E VG S M U

2. Quality of products/services furnished. E VG S M U

3. Overall rating of contractor's quality of service . E VG S M U

BUSINESS RELATIONS

1. Contractor's ability to correct problems and prevent or mitigate potential E VG S M U problems in a timely manner.

2. Contractor's ability to use effective approaches and provide technical E VG S M U expertise and resources to solve contract problems.

3. Contractor’s willingness to improve and correct noncompliance issues. E VG S M U

4. Contractor's overall rating of customer satisfaction. E VG S M U

MANAGEMENT OF KEY PERSONNEL

1. Contractor's ability to meet appropriate staffing levels with qualified E VG S M U personnel in order to meet requirements.

2. Rate the contractor's ability to replace key personnel in a timely fashion. E VG S M U

3. Overall rating of contractor's management of key personnel. E VG S M U

COMPLIANCE WITH LABOR, ENVIRONMENTAL, SAFETY, AND HEALTH REQUIREMENTS

1. Has the contractor ever received an notices of violations for noncompliance E VG S M U with labor laws, safety regulations, or other regulations?

2. Contractor's compliance with safety requirements. E VG S M U

2. Contractor's compliance with security requirements. . E VG S M U

CONTRACTUAL CONSIDERATIONS

1. Has an election ever been made not to exercise an option or continue relations YES* NO due to contractor's poor performance?

2. Has a Contract Discrepancy Report ever been issued? YES* NO

3. Has this contract been partially or completely terminated for default or YES* NO convenience? Partially _________ Completely ___________

4. Overall rating of contractor's performance. E VG S M U

5. Would you contract with or hire this contractor again? YES NO*

1. What role in contract administration did you perform (ie: CO, COR) and for how long? ______________________

2. Describe the work that the contractor completed for you.

3. If the contract included management of an operator certification program, on average, how many operator applications did they process annually?____

4. If the contract included management of an operator certification program, did the contractor efficiently and accurately maintain certification and application records? Yes____/No____

Explain.____________________________________________________________________________________

5. If the contract included providing trainings, did the contractor advertise their services and encourage operators to participate? Yes____/No____

Explain.____________________________________________________________________________________

6. How many people on average were trained annually?__________

NOTE: For any Exceptional, Marginal, or Unsatisfactory ratings assessed by the customer when completing this form, please include an explanatory narrative in the “remarks” block below.

*REMARKS

Are you aware of other relevant past efforts performed by this company? If yes, please provide the name and telephone number of a point of contact.