6991PE20Q000024 Past Performance Questionnaire.pdf

Past Performance Questionnaire Page | 1

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT/PROJECT INFORMATION (Contractor/Vendor only completes section 1-4)

1. Client Information:

Address:

Phone Number:

Point of Contact:

Email:

2. Work Performed as: (Check all that apply)

Prime Contractor Sub Contractor Joint Venture Other:

3. Type of Contract: (Check all that apply)

FFP FFP-EPA CPFF – Completion CPFF-Term CPIF CPAF

ID/IQ BOA Requirements Labor Hour T&M CR Other:

4. Contract/Project Name:

Contract/Project Number (If Applicable):

Location:

Period of Performance:

Value:

5. Contract/Project Description:

SOLICITATION 6991PE20Q000024

BLANKET PURCHASE AGREEMENT FOR SPECIALIZED

COVID-19 CDC DISINFECTING SERVICES

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PLEASE SELECT THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR

EVALUATION OF THE CONTRACTOR’S PERFORMANCE

1. Ability to meet quality standards specified for technical performance

2. Quality of work

3. Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports

4. Effectiveness of on-site management, including management of subcontractors

5. Business ethics/behavior

6. Timeliness/effectiveness of contract problem resolution with extensive customer guidance

7. Cost Control

8. Ability to successfully respond to emergency situations

9. Responsiveness regarding safety issues

10. Timeliness of performance

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

12. Would you select the firm again?

Any additional comments related to the contractor’s performance:

Name/Title of Person Completing the Form Signature Date

Release of Information: This Contractor Performance Report may be used to support future award decisions, and will be treated as source selection information in accordance with FAR 3.104-4(k)(1)(x) and 42.1503(b). The completed report shall not be released to other than Government personnel and the contractor whose performance is being evaluated during the period the information is being used to provide source selection information.