Past_Performance_Questionnaire.pdf

Instructions: this form may be used to document your past performance. Forward this form to your reference(s). Request they complete the form and return it to the Contracting Officer before the offer due date and time.

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name:_______________________ Telephone Number: __________________

Address: _______________________________ Fax Number: ________________________

_______________________________ Point of Contact: _____________________

Project Title and Brief Description of Work: _____________________________________

Contract Number Provided by Offeror: ___________________ Dollar Amount: _________

Contract Period or Dates of Performance Provided by Offeror: _______________________

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

Authorization is hereby granted to provide the information requested on this questionnaire:

Signature of Authorized Offeror Representative Date

Printed Name and title of Authorized Offeror Representative

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________________ Telephone Number: ___________________

_____________________________ Fax Number: ________________________

_____________________________ Email Address: _______________________

C. FAX or E-mail COMPLETED SURVEY FORM TO: TANYA ARNBERGER

Fax: 208-373-4197

E-mail: TEARNBERGER@fs.fed.us

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE

EXPLANATION FOR ANY RATINGS OF M or U.

AG-0261-S-14-0132

Attachment 5

E G S M U N

Exceptional Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet some contractual requirements.

The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: ______________ _

CONTRACT NUMBER: __ _____________

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U N

Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

Delegated authority to project managers and supervisors commensurate with contract requirements.

4 Home office participated in solving significant local problems.

5 Followed approved quality control plan.

Provided effective quality control and/or inspection procedures to meet contract requirements.

Corrected deficiencies in timely manner and pursuant to their quality control procedures.

8 Provided timely resolution of contract discrepancies.

9 Identified problems as they occurred.

10 Suggested alternative approaches to problems.

11 Displayed initiative to solve problems.

12 Was responsive to contract changes.

13 Provided adequate project supervision.

14 Cooperated with Government/company personnel after award.

15 Timely in correcting deficiencies after they were identified?

16 How would you rate the contractor's overall performance?

Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

YES NO

Would you award another contract to this contractor? If not, explain in “remarks.”

YES NO

19 Is the contractor rated in CPARS? YES NO

Remarks:__________________________________________________________________________________