36C24818Q0295-005.docx

PAST PERFORMANCE QUESTIONAIRE Attachment E

Gainesville, FL 32601-3456

I. CONTRACT INFORMATION

1. Name/Address of company being evaluated:

2. Is company listed in Question #1 the primary Contractor or a Subcontractor?

3. Contract Number:

4. Period of performance (include option years, if any):

5. Estimated annual contract amount

6. Brief description of services/supplies provided:

INSTRUCTIONS

Please include a brief explanation for all ratings. For each question/item under Sections II, III, IV, and V, choose the adjective that best describes the contractor's work on the project. Provide your comments on the comment lines. If a specific question/item does not pertain to your contract, write "N/A." The adjective scale is defined below:

Excellent - Contractor clearly excelled in performing the requirements of the contract.

Good - Contractor met all requirements of the contract.

Fair - Contractor substantially met all requirements of the contract.

Unacceptable - Contractor did not meet the requirements of the contract.

Please be sure to sign and date the questionnaire in Section VII.

II. OVERALL CONTRACT PERFORMANCE

Rating: □Excellent □ Good □Fair □Unacceptable Comment

III. TECHNICAL PERFORMANCE

1. To what extent did the Contractor respond positively and promptly to technical direction and/or technical revisions to the contract?

Rating: □Excellent □ Good □Fair □Unacceptable

Comment

2. To what extent did the Contractor display the ability to identify and solve technical problems that arose during contract performance in an effective and expeditious manner?

Rating: □Excellent □Good □Fair □Unacceptable Comment

3. To what extent did the Contractor use effective escalation procedures when technical problems arose?

Rating: □Excellent □Good □Fair □Unacceptable Comment

IV. MANAGEMENT PERFORMANCE

1. To what extent was the Contractor able to recruit and maintain qualified and reliable personnel for the duration of the contract? Was recruitment timely? Was turnover rate low?

Rating: □Excellent □Good □Fair □Unacceptable Comment

2. To what extent was the Contractor able to manage the overall performance of the contract? Include items such as, planning, scheduling, monitoring, billing and reporting.

Rating: □Excellent □Good □Fair □Unacceptable Comment

3. To what extent was the Contractor effective in interfacing with your staff and other contractors and in displaying a team approach to accomplish work when applicable?

Rating: □Excellent □Good □Fair □Unacceptable Comment

4. To what extent did the Contractor coordinate, integrate, and provide for effective subcontractor management?

Rating: □Excellent □Good □Fair □Unacceptable Comment

V. CUSTOMER SATISFACTION

1. How would you rate the Contractor’s ability to demonstrate a cooperative, business-like attitude and concern with the interests of your agency or company?

Rating: □Excellent □Good □Fair □Unacceptable Comment

2. Has the Contractor ever been given a cure notice, show cause notice, suspension of progress payments, letters of direction, or other written notification of unsatisfactory performance or progress?

Yes/No

Comment

3. Have you ever terminated a contract with this Contractor, on this or any other contract?

Yes/No

Comment

4. Would you recommend the Contractor for another contract award? Yes/No Comment

5. Were there any other problems on the contract? Yes/No Comment

VI. NARRATIVE SUMMARY

Please use the following space to add any other information not included above that you feel would be beneficial to concerning the award of this contract.

Comment

VII. CLIENT INFORMATION

The following information refers to the individual completing the questionnaire:

Name and Title (Printed)

Organization (Agency or Company)

Phone Number

Signature and Date

Thank you for your time and effort to help us evaluate this Contractor.

Please return the completed questionnaire via fax to (352) 381-5746; email to shirley.courtney@va.gov or mail: Commerce Bldg. Ste. 180, 300 E. University Ave.

Gainesville, FL 32601-3459