PAST PERFORMANCE QUESTIONNAIRE.docx

Attachment 2 – Past Performance Questionnaire

PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection.

Please complete this Questionnaire and return it via email to: Isabell Coad (isabell.coad@va.gov)

Desired Response Date: at time of proposal due date

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

1a. CONTRACTOR NAME & ADDRESS:

2. CONTRACT NO.:

3. CONTRACT AWARD DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

1b. NAME OF PRIME CONTRACTOR (If this questionnaire is for a team member)

6. TYPE OF CONTRACT:

7. PROJECT TITLE, LOCATION, AND DESCRIPTION (AND TOTAL CONSTRUCTION VALUE AT PROJECT COMPLETION):

Please add a continuation page if additional space necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION (Project Manager/ COR/ Other) AND ORGANIZATION:

b. EVALUATOR'S PHONE NUMBER: c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

Please circle the response code 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 safety and health standards).

E G S M U N/O

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

E G S M U N/O

C. Schedule – Assess the timeliness of contractor against the schedule of activities.

E G S M U N/O

D. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract.

E G S M U N/O

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

E G S M U N/O

F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”.

E G S M U N/O

G. Overall Assessment.

E G S M U N/O

Comments (for any ratings of E, G, M, or U, please provide some brief comments about strengths & weaknesses you observed in this contractor that help us understand your rating. Feel free to provide additional pages if necessary):