Past Performance Evaluation Questionnaire.rtf

The Desert Sage Youth Wellness Center (DSYWC)

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM

Co: Contract No.:

POC: Title: (Name)

The following questions pertain to the contractor’s record of past (within the past three years) and current performance. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

Outstanding: Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective.

Good: Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Acceptable: Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal: Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective.

Unacceptable: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective.

PART I. CONTRACT IDENTIFICATION

Contractor:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Period of Performance:

PART II. EVALUATION (To be completed by Point of Contact – Respondent)

Timeliness: Was the contractor's work completed on schedule?

Outstanding Good

Unsatisfactory

Comments:

Quality of Work: Did the contractor deliver high-quality work that met specifications?

Outstanding Good

Unsatisfactory

Comments:

Communication: How effective was the contractor's communication throughout the project?

Would always meet before any projects outside of contract and discuss the entire project Outstanding Good

Unsatisfactory

Adherence to Specifications: Did the contractor adhere to project requirements and specifications?

Outstanding

Unsatisfactory

Problem Resolution: How did the contractor handle any issues or challenges that arose during the project?

Outstanding

Unsatisfactory Comments:

Problem Resolution: How did the contractor handle any issues or challenges that arose during the project?

Outstanding Good

Unsatisfactory

Additional Comments:

Please provide any additional comments or insights about the contractor's performance:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to the Contracting specialist, Alicia Powell at Alicia.powell@ihs.gov Thank you for your assistance.