21.4__PAST_PERFORMANCE_QUESTIONNAIRE.pdf

DEPARTMENT OF ENERGY

Western Area Power Administration

Desert Southwest Customer Service Region P.O. Box 6457

Phoenix, AZ 85005-6457

PAST PERFORMANCE QUESTIONNAIRE

Solicitation No.: 89503119QWA000071

SECTION I. CONTRACT IDENTIFICATION

CONTRACTOR NAME: CONTRACT NO:

CONTRACTOR ADDRESS:

CONTRACT TYPE:

FIRM-FIXED-PRICE

COST REIMBURSEMENT

OTHER: (specify)

ACTIVE COMPLETED

ROUTINE COMPLEX

DATES OF PERFORMANCE:

AWARD AMOUNT: $

TOTAL WITH MODS: $

PROJECT DESCRIPTION:

SECTION II. AGENCY (REQUESTOR) IDENTIFICATION

AGENCY (CUSTOMER) NAME: WAPA –DSW Phoenix, AZ

POC NAME AND TITLE: Jeannine Veitz, Contract Specialist PHONE: 602-605-2999 EMAIL: jveitz@wapa.gov

SECTION III. PAST PERFORMANCE RATING

Rating Scale: E = Excellent. Considerably surpassed requirements/expectations.

G = Good. Surpassed requirements/expectations.

S = Satisfactory. Met requirements/expectations M = Marginal. Met some requirements/expectations

U = Unsatisfactory. Did not meet requirements/expectations

2. QUALITY: (Circle applicable rating)

a. Conformance with contract requirements E G S M U

b. Quality of workmanship (including subcontractors) E G S M U

c. General oversight by project manager and superintendent E G S M U

d. Coordination with and control of subcontractors E G S M U

f. Avoidance of accidents/safety violations E G S M U mailto:jveitz@wapa.gov

WAPA–DSW Solicitation No. 89503119QWA000071 Page 2 of 2

3. TIMELINESS: (Circle applicable rating)

a. Adherence to project delivery schedules E G S M U

b. Submission of change proposals E G S M U

c. Response to technical direction and change orders E G S M U

d. Response to correction of identified problems E G S M U

e. Submission of timely/accurate/complete billings E G S M U

f. Submission of materials/other submittals E G S M U

4. BUSINESS RELATIONS: (Circle applicable rating)

a. Flexibility and cooperativeness in resolving problems E G S M U

b. Tenacity and innovativeness in resolving problems E G S M U

c. Relationships with subcontractors, including prompt payment E G S M U

d. End user was satisfied with services performed E G S M U

SECTION IV. COMMENTS FOR M = MARGINAL AND U = UNSATISFACTORY RATINGS

Item No. Comment

PRINTED NAME: __________________________________ DATE:_______________

SIGNATURE: ______________________________________