Attachment_6_Past_Perf_questionaire.docx

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Attached to
Herbicide Broadcast Application wit Skidder Federal contract opportunity
Solicitation number
AG-4670-S-16-0080
Issued by
Department of Agriculture Forest Service

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Atch 6 Past Performance Questionnaire

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ATTACHMENT 6

AG-4670-S-16-0080

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

SECTION A: CONTRACTOR INFORMATION

A. Contractor’s Name and Address: ________________________________________________

B. Point of Contact: ______________________________________________________________

C. Phone #: ____________________________________________________________________

D. Contract Number: ______________________ Contract Type: ________________________

E. Project Title: _________________________________________________________________

F. Period of Performance: _________________________________________________________

G. Description of work performed: __________________________________________________ Use of only a project title does not usually provide enough detail to determine what work was performed.

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

Signature of Authorized Contractor Representative Date

Printed Name and Title of Authorized Contractor Representative

RESPONDENT INFORMATION:

A. Name:______________________________________ B. Position:________________ C. Telephone Number:_____________________ Fax Number: ______________ D. Address:___________________________ E. Relationship and Time Involved with Contractor:___________________ F. Date Questionnaire Completed:_______________________

SECTION B:

E

VG
S
N
M
U
Excellent
Very Good
Satisfactory
Neutral
Marginal
Unsatisfactory

CONTRACT PERFORMANCE

1.
Working relationship with your Company
E
VG
S
N
M
U
2.
Did the contractor provide experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements? If no, please explain in remarks below.
Yes

No

N/A

3.
Exhibited knowledge of and compliance with government (or other) regulations and industry standards
E
VG
S
N
M
U
4.
Did the contractor provide and properly maintain operational equipment throughout the term of the contract? If no, please explain in remarks below.
Yes

No

N/A

5.
Did the contractor demonstrate the ability to hire, maintain, and replace, if necessary qualified personnel during the contract? If no, please explain in remarks below.
Yes

No

N/A

6.
Does the contractor provide timely and accurate records? If no, please explain in remarks below.
Yes

No

N/A

7.
How well did the contractor comply with Environmental, health and security requirements
E
VG
S
N
M
U
8
Would you award similar contracts to this contractor? If no, please explain in remarks below.
Yes

No

N/A

9.
Contractor’s Overall Performance
E
VG
S
N
M
U

QUALITY OF SERVICE/CONTROL

1.
Contractor’s accomplishment in meeting the quality standards
E
VG
S
N
M
U
2.
Did the contractor provide an effective quality control plan or inspection procedures to meet contract requirements? If no, Please explain in remarks below.
Yes

No

N/A

3.
Overall Quality of Service/Control
E
VG
S
N
M
U

TIMELINESS OF PERFORMANCE

1.
Was the job/contract started and completed on time? If no, please explain in remarks below.
Yes

No

N/A

2.
Did the contractor have a system or method to track progress on all work in progress? If no, please explain in remarks below.
Yes

No

N/A

SAFETY

1.
How well did the contractor comply with safety requirements?
E
VG
S
N
M
U
2.
Did the contractor provide a workplace free of any OSHA Safety violations? If no, please explain in remarks below.
Yes

No

N/A

At REMARKS: If additional remarks are necessary, please attach an additional sheet.

Please E Mail completed document to Mark J Miller at markjmiller@fs.fed.us

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