Appendix_A_-_Past_Performance_Questionnaire.pdf

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APPENDIX A

PAST PERFORMANCE QUESTIONNAIRE

TITLE / ABSTRACT SERVICES, State of North Dakota United States Department of Agriculture (USDA) Natural Resources Conservation Services (NRCS)

AG-3C78-S-17-0041

Name of Contractor:

Contract Information

Name of Reference Organization:

Contract No:

Contact Title:

Contract Value:

Type of Contract:

Period of Performance:

The ratings below are supplied by the reference identified above, NOT the contractor.

Performance Elements Excellent Good Satisfactory Marginal Unsatisfactory Not

Applicable

1. Quality of Product or Service

2. Timeliness of Performance

3. Effectiveness of Management (including subcontractors)

4. Response to Technical Direction

5. Responsiveness to Performance Problems

6. Overall Performance

1. Remarks on excellent performance: (Provide data supporting this observation. You may continue on a separate sheet if needed.)

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2. Remarks on unsatisfactory performance: (Provide data supporting this observation. You may continue on a separate sheet if needed.)

3. Please identify any corporate affiliations with the contractor.

4. Would you do business with again? YES NO (Insert contractor’s name) (Circle one)

5. Information provided by:

Name Mailing address (Street and P.O. Box)

Title City, State and Zip Code

Time of Call Telephone and Fax Numbers

6. Questionnaire completed by:

Date Signature and Title of COE Employee

Please email the completed Questionnaire to:

Stephen D Case Contract Specialist USDA-

NRCS NSDT 3

4407 Bland Road, Suite 205 Raleigh, NC 27609 Phone: 919-873-2121 Email: stephen.case@wdc.usda.gov mailto:steven.alves@wdc.usda.gov