Attachment_4_-_Past_Performance_Questionnaire.docx

ATTACHMENT 4

PAST PERFORMANCE QUESTIONNAIRE

Solicitation No. 68HE0219Q0007

This is a past performance questionnaire for the U.S. Environmental Protection Agency (EPA) to obtain past performance information on the contractor listed below. You should have received this questionnaire along with a Client Authorization Letter requesting your cooperation in completing this questionnaire. Information obtained in this questionnaire is for the sole purpose of evaluating the contractor’s past performance history to assist EPA in determining the best value for award of a contract resulting from EPA’s solicitation. As a reviewer, your participation in this questionnaire is greatly appreciated.

INSTRUCTIONS to complete this questionnaire, the reviewer should:

1. Review the Client/Contract Information section on the following page.

2. Complete items 1-10 of the questionnaire on the following page.

3. Return the questionnaire to powell.sheri@epa.gov prior to proposal due date and time (contractor will provide this information to you).

QUESTIONS

If you have any questions about completing or submitting this questionnaire, please contact: Sheri D. Powell at 212-637-3356.

SOURCE SELECTION SENSITIVE INFORMATION

Name of Offeror: _________________________________________________

Client/Contract Information

Name of Client: ___________________________ Contract Number: __________________

Contract Title: ____________________________ Contract Value: ____________________

Type of Contract: __________________________ Period of Performance: ______________

Brief description of Contract or Subcontract and Relevance to this requirement:

The ratings below are supplied by the client identified above, NOT the offeror.

Place an “X” in the box that best describes the performance level for each performance element. Please use the rating guide on the reference page to assess the offeror’s performance under the contract identified above.

1. Quality of Product or Service

2. Schedule

3. Cost Control

4. Management

5. Remarks on exceptional performance:

Provide data supporting this observation; you may continue on a separate sheet if needed.

6. Remarks on unsatisfactory performance:

Provide data supporting this observation; you may continue on a separate sheet if needed.

7. Please identify any corporate affiliations with the offeror.

8. Other comments that you wish to make:

10. Questionnaire completed by:

Name:

Title:

Mailing Address (Street and P.O. Box): City, State and Zip Code:

Telephone Number:

Date Information provided:

FOR REFERENCE ONLY

Ratings and Performance Elements

The offeror shall be assessed based on the following ratings and performance categories:

Ratings:

Performance Elements:

Quality of Product or Service. Assess the Contractor's conformance to contract/order requirements, specifications and standards of good workmanship (e.g., commonly accepted technical, professional, environmental, or safety and health standards).

Schedule. Assess the timeliness of the Contractor against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements (e.g., efforts that contribute to or effect the schedule variance).

Cost Control. Assess the Contractor's effectiveness in forecasting, managing, and controlling contract/order cost.

Management. Assess the integration and coordination of all activity needed to execute the contract/order, specifically the timeliness, completeness and quality of problem identification, corrective action plans, proposal submittals, the Contractor's history of reasonable and cooperative behavior (to include timely identification of issues in controversy), customer satisfaction, timely award and management of subcontracts.