Past Performance Questionnaire- FY 2011.doc

PAST PERFORMANCE QUESTIONNAIRE

Sample Hauling Services PLEASE RETURN THIS DOCUMENT TO USDA BY August 12, 2011 The United States Department of Agriculture recently released a solicitation for a contractor to provide Sample Hauling Services for the AMS Cotton Program. Offerors were asked to provide information on contracts of similar size and service which they had performed in the past. An Offeror has submitted you as a reference for past performance. (See blocks 1 & 2 below)

We need your opinion on how well the Contractor performed on your contract. Please fill out the attached questionnaire and fax to Beverly Brown at 901-384-3021. USDA may contact you to clarify or verify any information provided.

Your input will be confidential. Please note your comments will be used to form the basis for evaluation of this Offeror. Thank you in advance for your assistance. If you have any questions, please contact, Beverly Brown at 901-384-3099 ext. 3103 or BeverlyS.Brown@ams.usda.gov.

CERTIFICATION

By law, the Government will not disclose the names of individuals providing reference information during discussions with the contractor identified in Block 1 below.

Block 1. Contractor/Offeror’s Name: |

Block 2. Contract Name/Identifier:

I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS QUESTIONNAIRE IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

Reference/Company Name

Evaluator’s Printed Name

Title/Role (e.g. Program Manager, Contracting Officer)

Evaluator’s Mailing Address (Agency, Bldg/Rm, Street, City, State, Zip

Evaluator’s Signature

Date

Phone

Fax

Past Performance Questionnaire

Please provide comments for each answer given. Please add additional pages as necessary.

1.

Describe the type of contract you had with the contractor?

2.

How long was the contractor under contract with your organization/company?

3.

Did the contractor provide a quality product or service? (Please provide comments with your answers.)

· Excellent – Contractor provided an excellent product/service – no problems

· Good – Contractor provided a good product/service – very few (3 or less) problems

· Fair – Contractor provided a fair product/service – several (more than 3 but less than 6) instances of problems

· Poor – Contractor provided a poor product/service – many (greater than 6) problems occurred

4.

Did the contractor have the appropriate number of personnel, materials and equipment to perform the contract requirements? (Please provide comments with your answers.)

· Excellent – Contractor provided appropriate number of employees/trucks needed to perform the service

· Good – Contractor had a few problems (3 or less) with personnel/equipment

· Fair – Contractor had several (more than 3 but less than 6) problems with personnel/equipment

· Poor – Contractor had many (greater than 6) problems with contractor personnel/equipment

5.

Were there any problems in performing the contract requirements? (Please provide comments with your answers.)

· Excellent – Contractor experienced no problems in performing the contract requirements

· Good – Contractor experienced few (3 or less) problems in performing the contract requirements

· Fair – Contractor experienced several (more than 3 but less than 6) problems in performing the contract requirements

· Poor – Contractor experienced many (greater than 6) problems in performing the contract requirements

6.

Did the contractor resolve problems encountered to meet the satisfaction of the destination and pickup locations? (Please provide comments with your answers.)

· Excellent – Problems were resolved immediately

· Good – Problem were resolved within 1-2 days

· Fair – Problems were resolved within 3-4 days

· Poor – Problems were resolved 5 days or longer

7.

Did the contractor promptly notify you of any problems in performing the contract requirements? (Please provide comments with your answers.)

· Excellent – Contractor promptly notified us of any problems

· Good – Contractor took 1-2 days to notify us of any problems

· Fair – Contractor took 3-4 days to notify us of any problems

· Poor – Contractor took 5 days or longer to notify us of any problems

8.

Did the contractor meet the pickup and delivery schedule as agreed by the destination and pickup locations? (Please provide comments with your answers.)

· Excellent – Contractor met pickup and delivery schedule

· Good – Contractor did not meet all pickup and delivery schedules (3 or less times)

· Fair – Contractor did not meet all meet all pickup and delivery schedules (more than 3 times but less than 6 times)

· Poor – Contractor did not meet all meet all pickup and delivery schedules (more than 6 times)

9.

Did the contractor stay on schedule despite any problems that may have occurred? (Please provide comments with your answers.)

· Excellent – Contractor stayed on schedule despite problems/no problems

· Good – Contractor was off schedule by 1-2 days because of problems

· Fair – Contractor was off schedule by 3-4 days because of problems

· Poor – Contractor was off schedule 5 or more days because of problems

10.

Did the contractor provide effective management of the contract? (Please provide comments with your answers.)

· Excellent – Contractor effectively managed the contract.

· Good – Contractor had few (less than 3) problems managing the contract.

· Fair – Contractor had some (more than 3 less than 6) problems managing the contract.

· Poor – Contractor had many (more than 6) problems managing the contract.

11.

Did the contractor experience numerous staff turnover under the contract? (Please provide comments with your answers.)

· Excellent – Contractor had no staff turnover under the contract

· Good – Contract had few(3 or less) instances of staff turnover under the contract

· Fair – Contractor had some (more than 3 but less than 6) instances of staff turnover under the contract

· Poor – Contractor had many (greater than 6) instances of staff turnover under the contract

12.

Did the contractor provide good customer service? (Please provide comments with your answers.)

· Excellent – Excellent customer service/no problems encountered

· Good – Good customer service/few problems (3 or less) encountered

· Fair – Fair customer service/several (more than 3 but less than 6) problems encountered

· Poor – Poor customer service/many (greater than 6) problems encountered

13.

Were your end users satisfied with the contractor's service? (Please provide comments with your answers.)

· Excellent – No problems reported

· Good – A few problems (3 or less) reported

· Fair – Several (more than 3 but less than 6) problems reported

· Poor – Many (greater than 6) problems reported Additional Comments.