ATTACHMENT_E_-_PBS_Past_Performance_Questionnaire_-_Postal_Square_Building_CFM_RFP_47PM0717R0002_-_Rev_1.docx

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PBS PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor/Offeror to complete Blocks 1-4)

1. CONTRACTOR/OFFEROR INFORMATION

Firm Name: Address:

Phone Number: DUNs Number:

Contact Name Email Address: : Contact Phone Number:

Percent (%) of project work performed:

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

3. CONTRACT INFORMATION

Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please explain) Contract Title:

Contract Location:

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.)

INSTRUCTIONS FOR CLIENTS COMPLETING THIS QUESTIONNAIRE: PBS requests that the client completes this questionnaire and submits it directly back to the offeror. The offeror will submit the completed questionnaire to PBS with their proposal, and may duplicate this questionnaire for future submission on PBS solicitations. Clients are highly encouraged to submit questionnaires directly to the offeror. However, questionnaires may be submitted directly to PBS. Please contact the offeror for PBS POC information. The government reserves the right to verify any and all information on this form.

TO BE COMPLETED BY CLIENT

CLIENT INFORMATION

Client Point of Contact Information Name: Title:

Phone Number: Email Address:

Project Information Contract Type: Contract Title: Contract Location:

Describe your role in the project:

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

Client’s Signature:

PERFORMANCE HISTORY:

1. Was Offeror responsible for operations and maintenance of this building?

Yes No

COMMENTS:

2. Were the services throughout the contract provided by Offeror acceptable?

Yes No

COMMENTS:

3. Did the Offeror communicate effectively?

Yes No

4. Did the Offeror generally respond timely to service calls and other complaints?

Yes No

5. Was the Offeror generally cooperative??

Yes No

6. Did the Offeror observe all required policies and procedures?

Yes No

COMMENTS

7. Did the Offeror adhere to relevant safety requirements?

Yes No

8. After accounting for a reasonable learning curve, was the Offeror competent?

Yes

9. Would you contract with this firm again for a similar requirement?

Yes

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