Attachment__3_-_PAST_-_PRESENT_PERFORMANCE_CUSTOMER_QUESTIONNAIRE.pdf

AG-32SD-S-16-SR10

PAST PERFORMANCE CUSTOMER QUESTIONNAIRE

The Offeror/Contractor listed is being considered in a Source Selection by the USDA – Agricultural Research Service. This is a request for past performance information on a project the Offeror has identified as being relevant to this solicitation. This information will be used in the evaluation of the Offeror's performance of that project. The following information, once submitted, will be treated as confidential and will not be released. This information will only be used to evaluate this Offeror for this solicitation. Please complete the following questionnaire utilizing the following guidance:

a. Handwritten responses are sufficient.

b. Circle a rating as listed below and provide a brief supporting narrative for your area of administrative responsibility. In the event of any unsatisfactory performance, please describe the cause and corrective actions, and any other pertinent information relative to the contractor's inadequate performance.

c. The assessment questions contained in this questionnaire shall be rated pursuant to the following definitions:

Exceptional (E) - Indicates the contractor's performance exceeded the contractual requirements.

Satisfactory (S) - Indicates there were no major problems that were not quickly and effectively solved by the contractor, and the contractor was meeting all contractual requirements.

Marginal (M) - Indicates the area of evaluation contained major problems that were not effectively solved by the contractor. The contractor met basic contract requirements with assistance from the customer. Please include any written documentation supporting this rating.

Unsatisfactory (U) - Indicates a serious problem existed on the part of the contractor that precluded the contractor from meeting the contractual requirement(s). Please include any written documentation supporting this rating.

N/A - Not applicable or observed.

d. Please return the completed forms to the USDA-ARS-Western Business Service Center:

Shannon Robbie, Contracting Officer

USDA-ARS-Western Business Service Center Phone: 970-492-7016

E-mail: Shannon.Robbie@ars.usda.gov

PAST PERFORMANCE CUSTOMER QUESTIONNAIRE PROJECT:

The USDA – Agricultural Research Service, is interested in your assessment of the name company’s “past performance”. Past performance refers to the company’s record of conforming to contract requirements and to standards of good workmanship; the company’s record of forecasting and controlling costs; the company’s adherence to contract schedules including administrative aspects of performance;

the company’s history of reasonable and cooperative behavior and commitment to customer satisfaction;

and the company’s general business-like concern for the interest of the customer. These questions relate to work performed by:

Contractor under review: (Insert Company Name)

Name and Location of Project:

Respondent Identification:

Name Date Company/Organization Position/Job Title Telephone Number

Questionnaire:

1. Is the information provided by the contractor on the Project Information accurate and correct to the best of your knowledge? Yes ( ) No ( )

2. What type of work did the contractor perform?

3. How would you rate the contractor's overall performance?

E S M U N/A

4. How would you rate the contractor's overall corporate management, integrity, reasonableness, and cooperative conduct?

5. How would you rate the contractor's quality control program and performance on delivery of quality work?

6. How effective was the contractor in meeting completion requirements including punch list items and warranty work?

7. How efficient and timely were the services performed (compliance with the schedules of completion)?

8. Please circle the statement that best describes your feelings with regard to the contractor.

a. They were an outstanding contractor in every respect. Problems were solved in a spirit of teamwork. Quality work, timely actions, and complete documentation were routinely achieved.

We would pay a premium price to contract with them again.

b. They were an above average contractor to whom we would not hesitate to award to again.

Problems encountered were minor and solutions were found with little difficulty.

c. They were an average contractor meeting the minimum requirements of the contract.

Performance deficiencies improved when identified by the client/agency.

AG-32SD-S-16-SR04

d. They were a below average contractor. Numerous problems developed that were a result of their lack of cooperation and failure to perform as required. An aggressive inspection program was required to ensure compliance.

e. They were a poor contractor who we would not want again under any circumstances. We would have been within our rights to terminate them for default.

f. None of the above. Please provide your statement.

9. Was the contractor given any of the following (or anything of a similar nature)?

Cure Notice: Yes No Show Cause Notice: Yes No Termination for Default: Yes No

10. If there are any additional comments, information, etc. that you would like to add to the survey that does not fall into any of the above categories, please indicate below:

Return to (email preferred method):

Shannon Robbie Contract Specialist/Warranted Contracting Officer USDA – ARS – Western Business Service Center 2150 Centre Avenue, Bldg D, Suite 300 Fort Collins, CO 80526-8119 Phone: (970) 492-7016 E-mail: Shannon.Robbie@ars.usda.gov