Attachment J6.pdf

US Department of Agriculture Natural Resources Conservation Service Attn: Alyson Keaton 6013 Lakeside Blvd.

Indianapolis, IN 46278

FAX: 317-290-3225

Email: alyson.keaton@in.usda.gov

N/O-No Opinion - No opinion can be offered based on your experience with the contractor.

EX-Exceptional - Performance meets contractual requirements and exceeds many to the Government's benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective action taken by the contractor were highly effective.

VG-Very Good-Performance meets contractual requirements and exceeds some to the Government's benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S-Satisfactory-Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

MG-Marginal-Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor's proposed actions appear only marginally effective or were not fully implemented.

US-Unsatisfactory-Performance does not meet those contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

4. Completion Date:

7. Description of Contract Requirements

Please add a continuation page if additional space is necessary.

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

5. Contract Value:

6. Type of Contract:

1. Contractor Name & Address:

Please circle the response code which best reflects your experience with this contractor.

8. EVALUATION: a. Evaluator's Name, Position (PCO/COTR/Other) and Address

b. Evaluator's Phone Number c. Duration of business relations with named firm:

TO BE COMPLETED BY CONTRACTOR

2. Contract Number:

3. Contract Initiation Date:

PAST PERFORMANCE/REFERENCE QUESTIONNAIRE

Your assistance is requested in support of a source selection/best value analysis.

Please complete this Questionnaire and mail or send by email or fax to the following not later than close of business May 26, 2010:

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

A. Working Relationship of Contractor with Project Owner EX VG S MG US N/O Cooperative Behavior EX VG S MG US N/O Cooperation/Communication with Project Owner EX VG S MG US N/O Cooperation/Communication with Subcontractors EX VG S MG US N/O Problem Resolution EX VG S MG US N/O Commitment to Project Owner Satisfaction EX VG S MG US N/O Responsiveness EX VG S MG US N/O Attendance at Project Meetings EX VG S MG US N/O

Personnel Technical Knowledge in Subject EX VG S MG US N/O Knowledge of and Compliance with Awarding Authority Standard EX VG S MG US N/O Knowledge of Work Performed EX VG S MG US N/O

C. Adherence to Schedule Adherence to Project Schedule Including Project Completion EX VG S MG US N/O Response to Directive EX VG S MG US N/O Submission of Project Schedule and Updates EX VG S MG US N/O Submission of Shop Drawings EX VG S MG US N/O Ordering/Delivery of Material EX VG S MG US N/O Payment to Subcontractors/Suppliers EX VG S MG US N/O Submission of Certified Payroll Affidavits EX VG S MG US N/O

D. Quality of Contractor's Team Staffing of Project Administration (Supervisory Personnel) EX VG S MG US N/O Contractor provided a superintendent as required in the conract EX VG S MG US N/O Accuracy (of product description and work) EX VG S MG US N/O Quality of Contractor's Required Documentation EX VG S MG US N/O Quality of Supervisory Personnel EX VG S MG US N/O Quality of Contractor's Work EX VG S MG US N/O Adequate Equipment to Perform Work EX VG S MG US N/O Thoroughness EX VG S MG US N/O Overall Quality EX VG S MG US N/O

E. Effectiveness of Management

Contractor’s Ability to Work Within Contractor’s Allotted Cost EX VG S MG US N/O

Accuracy of Contractor’s Billing EX VG S MG US N/O

Number and Cause of Change Orders EX VG S MG US N/O

Manner in Which Contractor Determined Price on the Change Order EX VG S MG US N/O

F. Compliance with Labor Standards

Thoroughness EX VG S MG US N/O

Accuracy (of product description and work) EX VG S MG US N/O

G. Compliance with Safety Standards

Quality of Contractor’s Safety Program EX VG S MG US N/O

Adherence to OSHA Requirements EX VG S MG US N/O

Adherence to Contractor’s Safety Program EX VG S MG US N/O

Adherence to Security Rules of Awarding Authority EX VG S MG US N/O

9. Overall Assessment: (a) Exceptional (b) Very good (c) Satisfactory (d) Marginal (e) Unsatisfactory (f) Not Observed

10. Any unsatisfactory performance identified above has been shared with the contractor. ( ) Yes: written/oral ? ( ) No

Please provide comments to identify specific Strengths/Weaknesses in each area

B. Prior Experience

Please add a continuation page if necessary.

a. Specific Strenghs/Weaknesses Related to Part 8 Above--Please Cite the Alpha-Numeric Code

b. Two or Three Best Corporate "Traits" or Skills Observed

c. Any areas of performance that are most troublesome.

Please provide comments to identify: