A64-1079751 Questionnaire Survey.pdf

Past Performance Questionnaire

The U.S. Department of Agriculture Forest Service (FS) intends to acquire construction services. As part of the procurement process, an increased emphasis is being placed on past performance.

In order to accurately evaluate the offeror’s past performance, your assistance is requested in obtaining and verifying the past performance history of this offeror.

One form is provided to complete the evaluation. Upon completion of this form, please submit it as an e-mailed attachment to Sheri Eiri at sheri.eiri@usda.gov.

Please make the subject line of the e-mail read “12970223Q0004 – Past Performance Questionnaire – Insert Evaluated Company’s Name.”

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible. Comments to support ratings may be noted on last page. The Government will assess an overall past performance rating for each reference contacted. The overall ratings of each reference will then be combined to arrive at a final past performance rating that will be assigned points based upon the following rating scheme:

RATINGS ARE DEFINED AS FOLLOWS:

Definition and Description Excellent-The Contractor demonstrates an excellent performance level in all categories. There have been no performance problems and the Contractor has demonstrated initiative to enhance/exceed contractual requirements and objectives. The Contractor also has maintained an excellent Contractor/ Government relationship throughout contract performance

Good-There are no quality of service problems; no cost/price issues; and no delays. Responses to inquiries and technical/service administrative issues are consistently effective and responsive. Non-conformance does not impact achievement of contract requirements.

Acceptable-Non-conformances are minor and have little impact in achievement of contract requirements, requires minor intervention by Government personnel to resolve issues.

Marginal-Non-conformances are impacting achievement of contract requirements, requires substantial intervention by Government personnel to resolve issues.

Unacceptable -Non-conformances are compromising the achievement of contract requirements, despite substantive intervention by Government personnel.

Solicitation No.: 1270223Q0004 Project: Klamath National Forest Site Preparation and CXT Vault Toilet Installation

Projects of same or similar scope and size your business completed within the last five years.

SUBMIT TO:

USDA-Forest Service-PPS-SPOC-SW Attention: Sheri Eiri, Contract Specialist Email: sheri.eiri@usda.gov

Submitted for Contractor:

Address:

City/State/Zip:

SAM UID:

Solicitation: 12970223Q0004

Contract Number:

Contract Amount:

Project Description:

Point of Contact for Project Information:

Business Name:

Address:

Email:

Telephone:

POC:

Question Remarks:

Quality Did the contractor meet the quality requirements of the project?

Did the contractor maintain adequate quality control of the

Did the contractor have adequate type of personnel resources required to support the project?

Schedule Did the contractor complete the project on time?

Was the contractor successful in planning and proposing realistic schedules or implementing changes in a timely manner?

Management Did the contractor communicate effectively and focus on customer satisfaction?

Did the contractor respond in a timely manner regarding any corrective action plans, or problems identified on the project? Was the contractor reasonable and cooperative?

Did the contractor have adequate management assigned to the

Regulatory Did the contractor meet reporting requirements outlined in the FAR and/or safety requirements?

Solicitation No.: 1270223Q0004 Project: Klamath National Forest Site Preparation and CXT Vault Toilet Installation

(Examples: Labor Laws, OSHA, Safety Program, Hazardous Material Identification and Material Safety Data, Environmental)

Would you recommend the selection of this firm again? (Check one) __Yes / __No

Name/Title_____________________________ Date:______________________

Additional Comments: