36C25924Q0823_Past Performance Questionnaire_Blank.docx

PAST PERFORMANCE QUESTIONNAIRE

Irrigation and Concrete Repairs

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

Section D: Performance Information: Choose the letter on the scale that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY UNSATISFACTORY OR MARGINAL RATINGS.

Exceptional (Outstanding) Very Good (Above Average)

or were not fully implemented

1. QUALITY:

a) Quality of technical data/report preparation efforts

a.1. Comments:

b) Ability to meet quality standards specified for technical performance

E

VG

S

M

U

N b.1. Comments:

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance

S

M

U

N c.1. Comments:

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance)

VG

S

M

U

N d.1. Comments:

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below)

VG

S

M

U

N

2.a.1 Comments:

b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract

E

VG

S

M

U

N

2.b.1. Comments:

3. CUSTOMER SATISFACTION:

3. a.1. Comments:

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication)

S

M

U

3.b.1. Comments:

c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

E

VG

S

M

U

N

3.c.1. Comments:

3.d.1 Comments:

4. MANAGEMENT/ PERSONNEL/LABOR

a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force?

VG

S

M

U

N

4.a.1. Comments:

4.b.1 Comments:

4.c.1. Comments:

4.d.1. Comments:

4.e.1. Comments:

f) Ability to simultaneously manage multiple projects with multiple disciplines

E

VG

S

M

U

N

4.f.1. Comments:

g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes

E

VG

S

M

U

N

4.g.1. Comments:

h) Effectiveness of overall management (including ability to effectively lead, manage and control the program)

E

VG

S

M

U

N

4.h.1. Comments:

5. COST/FINANCIAL MANAGEMENT

a) Ability to meet the terms and conditions within the contractually agreed price(s)?

VG

S

M

5.a.1. Comments:

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

E

VG

S

M

U

N

5.b.1. Comments:

c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns)

S

M

5.c.1. Comments:

d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section.

Yes

No

5.d.1. Comments:

e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

5.e.1. Comments:

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

5.f.1 Comments:

6. SAFETY/SECURITY

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and

E

VG

S

M requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

6.a.1 Comments:

b) Contractor complied with all security requirements for the project and personnel security requirements.

6.b.1. Comments:

7. GENERAL

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

VG

S

M

U

N

7.a.1. Comments:

b) Compliance with contractual terms/provisions (explain if specific issues)

E

VG

S

M

U

N

7.b.1. Comments:

c) Would you hire or work with this firm again? (If no, please explain below)

7.c.1. Comments:

d) In summary, provide an overall rating for the work performed by this contractor.

E

VG

S

M

U

7.d.1. Comments:

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

STRENGTHS:

WEAKNESSES:

DEFICIENCIES:

COMMENTS:

Past Performance Information provided by:

(Printed Name)

Signature: Date: Organization: Phone: