PAST PERFORMANCE QUESTIONNAIRE TEMPLATE.docx

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Note: When completed this document is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

SUBJECT: Request for Past and Present Performance Evaluation

TO: (to be completed by the Offeror)

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the questionnaire below. This firm is currently being considered for a construction contract with the Department of Veterans Affairs, Network Contracting Office (NCO) 17, Solicitation # 36C25725R0056.

Your prompt attention to this questionnaire will be greatly appreciated. Please submit completed questionnaire via e-mail to nicholas.smith21@va.gov NLT the date and time specified in block 13 A of the Standard Form (SF) 1442. If you have any questions concerning this request, please email me at Nicholas.smith21@va.gov .

Sincerely, Nicholas Smith Contract Officer

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: (to be completed by the Offeror)

Contractor’s Name: LLC Telephone Number:

Contract Number: Tel/Fax Number:

Point of Contact (POC):

POC e-mail address:

Project Title and Brief Description of Work:

Title:

Description of Work

Contract Number: 605-20-427 Dollar Amount:

Final Cost:

Contract Performance Period: Project duration was 365 days initial scope completed in 305 days. Additional controls materials and scope extended the project to present date.

Contractor performed as the Prime Contractor Sub-Contractor

B. RESPONDENT INFORMATION:

Email Address:

C. E-MAIL COMPLETED SURVEY FORM TO: nicholas.smith21@va.gov

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E: Exceptional: Performance meets contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

S: Satisfactory: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

M: Marginal: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U: Unsatisfactory: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N: Neutral: Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: CONTRACT NUMBER:

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

The contractor:

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

E ___ S _____ M _____ U _____ N _____

2. Provided adequate project supervision.

E ____ S _____ M _____ U _____ N _____

3. Complied with all Federal and locals laws including OSHA, EPA, etc.

E _____ S _____ M _____ U _____ N _____

4. Provided effective inspection procedures which resulted in a quality finished project.

E _____ S _____ M _____ U _____ N _____

5. Corrected deficiencies in timely manner.

E _____ S _____ M _____ U _____ N _____

6. Provided timely resolution of contract discrepancies.

E _____ S _____ M _____ U _____ N _____

7. Identified problems as they occurred/ Suggested alternative approaches to problems.

E ____ S _____ M _____ U _____ N _____

8. Displayed initiative to solve problems.

E _____ S _____ M _____ U _____ N _____

9. Developed realistic progress schedules.

E ____ S _____ M _____ U _____ N _____

10. Was responsive to contract changes.

E _____ S _____ M _____ U _____ N _____

11. Provided accurate, and complete records E _____ S _____ M _____ U _____ N _____

12. Complied with standards of wood workmanship E _____ S _____ M _____ U _____ N _____

13. Paid subcontractors/suppliers in a timely manner.

E _____ S _____ M _____ U _____ N _____

14. Communicated with Government personnel to keep the project on schedule or minimize delays E _____ S _____ M _____ U _____ N _____

15. Was diligent in forecasting and controlling cost.

E _____ S _____ M _____ U _____ N _____

16. Provided timely and accurate billing.

E _____ S _____ M _____ U _____ N _____

17. Submitted reasonable priced change proposals.

E _____ S _____ M _____ U _____ N _____

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

E _____ S _____ M _____ U _____ N _____

19. Did you ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

Yes _____ No _____

20. Would you award another contract to this contractor? If not, explain in “remarks Yes _____ No _____

CONTRACTOR’S NAME:

CONTRACT NUMBER:

Remarks: