36C24420Q0558-030.pdf

PAST PERFORMANCE QUESTIONNAIRE

GENERAL INFORMATION:

Please correct any information below known to be inaccurate:

Contractor’s Name:

Telephone Number:

Address:

Fax Number:

Point of Contact:

Contract Period or Dates of Performance Provided by Offeror:

Project Title and Brief Description of Work:

Contractor performed as the:

[ ] Prime Contractor [ ] Sub-Contractor [ ] Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

RESPONDENT INFORMATION:

Name of Respondent:

Title:

Address:

Telephone Number:

Fax Number:

Email Address:

PERFORMANCE INFORMATION:

For the following questions:

Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation.

E G S M U N Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance Performance Performance Performance Performance Performance meets meets meets does not does not was not contractual contractual contractual meet some meet most observed or requirements requirements requirements. contractual contractual not with many with some The contractual requirements requirements applicable to exceeded to exceeded to performance of . The and recovery the current the the the element or contractual is not likely in effort being Government’s Government’s sub-element performance a timely reported benefit. The benefit. The contains some of the manner. The against.

contractual contractual minor problems element or contractual performance performance of for which sub-element performance of the element the element or corrective being of the or sub- sub-element actions taken by assessed element or element being being assessed the contractor reflects a sub-element assessed was was were serious contains a accomplished accomplished satisfactory. problem for serious with no more with no more which the problem(s) than a few than some contractor for which the minor minor problems has not yet contractor’s problems for for which identified corrective which corrective corrective actions corrective actions taken actions or appear or actions taken by the the were by the contractor were highly effective.

contractor was effective.

contractor’s proposed actions appear only marginally effective or were not fully implemented ineffective.

CONTRACTOR’S NAME: CONTRACT NUMBER:

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

CONTRACTOR’S NAME: CONTRACT NUMBER

The contractor: E G S M U N

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

4. Home office participated in solving significant local problems.

5. Followed approved quality control plan.

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

7. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

8. Provided timely resolution of contract discrepancies.

9. Identified problems as they occurred.

10. Suggested alternative approaches to problems.

11. Displayed initiative to solve problems.

12. Developed realistic progress schedules.

13. Met established project schedules.

14. Provided timely resolution of warranty defects.

15. Was responsive to contract changes.

16. Provided adequate project supervision.

17. Obtained consent of surety for increases in bonding as work-in-progress increased.

18. Paid subcontractors/suppliers in a timely manner.

19. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

20. Cooperated with Government personnel after award.

21. How would you rate the contractor's overall performance?

22. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” YES/NO

23. Would you award another contract to this contractor? If not, explain in

“remarks.” YES/NO

24. Is the contractor rated in CPARS? YES/NO

CONTRACTOR’S NAME: CONTRACT NUMBER

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

Remarks:

Note: While these questions are generic and will work as written in many acquisitions, consider them as they relate to each individual acquisition and tailor them as needed and appropriate. Also, when tailoring the form, consider leaving space between questions for comments.