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SOURCE SELECTION SENSITIVE WHEN COMPLETED
**NOT TO BE RELEASED OUTSIDE GOVERNMENT CHANNELS**
PAST PERFORMANCE QUESTIONNAIRE
US Department of Agriculture, US Forest Service, Region 4 – Payette NF is considering the firm listed below. Your comments would be appreciated regarding this firm’s past performance.
Past Performance Information:
| Name and Address of Firm Being Evaluated: | _____________________________________________ | |
| | _____________________________________________ |
| | _____________________________________________ |
Contract No.:________________________ Type of Contract:_______________________________ Project Title:_________________________ Date of Award:_______________________ Completion Date:_______________________________ Location:____________________________ Initial Amount:_______________________ Final Amount:__________________________________ Description:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Evaluator: (The following information will assist in the analysis of the data)
Name of Evaluator:__________________________________________________________ Company/Agency Name:______________________________________________________ Address:___________________________________________________________________ Phone Number:_____________________________________________________________ Email Address:______________________________________________________________ Position Held or Function in Relation to Project: __________________________________________________________________________
Rating: If the rating is “Unacceptable”, please provide additional information in the appropriate block or in the remarks section of this form.
| “O” | Outstanding | Performance greatly exceeded the contract requirements. | |
| “G” | Good | Performance exceeded the contract requirements. | |
| “A” | Acceptable | Performance met the contract requirements. | |
| “M” | Marginal | Performance met the minimum contract requirements but some material | |
| | | aspects of the contractor’s performance were less than satisfactory. |
| “U” | Unacceptable | Performance was poor and/or did not satisfy contract requirements. | |
| Please circle the appropriate rating and provide any supporting information for the following: | | |
| 1 |
| The relationship between the firm and client’s/customer’s contract team: |
| O G A M U N/A |
| 2 |
| The firm’s management and coordination of subcontractors/consultants: |
| O G A M U N/A |
| 3 |
| Overall corporate management, integrity, reasonableness and cooperative conduct: |
| O G A M U N/A |
| 4 |
| Timeliness and quality of reports, deliverables, and other required submittals and documents: |
| O G A M U N/A |
| 5 |
| The firm’s business integrity: |
| O G A M U N/A |
| 6 |
| Responsiveness to client/customer’s requirements: |
| O G A M U N/A |
| 7 |
| Ability to control costs and provide the required work at a reasonable total price: |
| O G A M U N/A |
| 8 |
| Contract Compliance: |
| O G A M U N/A |
| 9 |
| Contract Management: |
| O G A M U N/A |
| 10 |
| Reasonable costs for modifications and change orders: |
| 11 |
| Compliance with safety standards and/or number of safety related incidents, code compliance, as applicable: |
| O G A M U N/A |
| 12 |
| Quality Control Procedures: |
| O G A M U N/A |
| 13 |
| Construction with combined structural materials (e.g. heavy wood, concrete, block) |
| O G A M U N/A |
| 14 |
| Experience with the following work items: |
| Construction Staking |
| O G A M U N/A |
| Earthwork, site preparation & grading |
| O G A M U N/A |
| Roads, drainage, culverts |
| O G A M U N/A |
| Aggregate base course & asphalt pavement |
| O G A M U N/A |
| Forming & concrete placement |
| O G A M U N/A |
| Permanent traffic control features |
| O G A M U N/A |
| Landscaping and seeding |
| O G A M U N/A |
| 16 |
| Have any cure notices, show cause letters, letter of reprimand, suspension of payment, or termination been issued? If yes please explain: |
Yes No
| 17 |
| Would you award another contract to the firm being evaluated: If no, please explain: |
Yes No
| 18 |
| Was the customer satisfied with the end product? If no, please explain: |
Yes No
| 19 |
| Has the firm being evaluated been provided an opportunity to discuss or respond to any negative comments or performance ratings? If so, what were the results? |
Yes No
| 21 |
| Overall rating for this firm: |
| O G A M U N/A |
Printed Name of Evaluator
| _______________________________________________________ | __________________________ | |
| Signature of Evaluator | | Date |
This questionnaire should be submitted to the US Forest Service via email to Marge Schafer at msschafer@fs.fed.us.
