SUPPORTING DOCUMENT C - GALENA PAST PERFORMANCE.pdf

SUPPORTING DOCUMENT – C

AG-0267-S-09-0015

SUBMIT FORM WITH PROPOSAL

SAWTOOTH SNRA GALENA

RECONSTRUCTION PROJECT

PAST PERFORMANCE QUESTIONAIRE

4 Pages

(including this header page)

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 PERFORMANCE QUESTIONAIRE

SECTION A: CONTRACTOR INFORMATION

A. Contractor’s Name and Address:

B. Point of Contact

C. Phone Number:

D. Contract Number

E. Project Title:

F. Period of Performance:

G. Brief Description/ Scope of Services:

H. Authorization is hereby granted to provide the information requested in SECTION B of this questionnaire:

Signature of Authorized Offeror Representative Date

Printed Name and Title of Authorized Offeror Representative

REFERENCE/RESPONDENT INFORMATION:

A. Name:

B. Position

C. Phone #

D. Address:

E. Relationship:

F. Date Questionnaire Completed:

PRESENT/PAST PERFORMANCE QUESTIONAIRE

RATING SCALE

E S M U N Exceptional Satisfactory Marginal Unacceptable No Rating

ONE CONTRACT PERFORMANCE

Working relationship with your company A

Did the contractor provide experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements? If no, please explain

B

YES NO N/A

Exhibited knowledge of and compliance with government (or other) regulations and industry standards?

C

Did the contractor provide and properly maintain operational equipment throughout the term of the contract? If no, please explain

D

Did the contractor demonstrate the ability to hire, maintain, and replace (if necessary) qualified personnel during the contract period? If no, please explain.

E

Does the contractor provide timely and accurate reports? F

How well did the contractor comply with environmental, safety, health and security requirements?

G

H Would you award similar contracts to this contractor? If NO, please explain in remarks.

YES NO N/A

CONTRACTOR’S OVERALL PERFORMANCE E S M U N

TWO QUALITY OF SERVICE/CONTROL

A. Contractor’s accomplishment in meeting the quality standards.

B. Did the contractor provide an effective quality control plan or inspection procedures to meet contract requirements? If no, please explain.

CONTRACTOR’S OVERALL QUALITY OF SERVICE/CONTROL E S M U N

THREE TIMELINESS

A War the job/contract started and completed on time? If not please explain why

B Did the contractor have a system or method to track all work in progress?

CONTRACTOR’S OVERALL TIMELINESS E S M U N

CONTRACTOR’S OVERALL EVALUATION RATING

REMARKS:

(Attach additional sheets if necessary)