Past_Performance_Questionnaire.docx

DOCX document 52 KB Posted

Attached to
Newtown Trailhead Improvement Project Federal contract opportunity
Solicitation number
AG-8191-S-16-0002
Issued by
Department of Agriculture Forest Service R3-Southwestern Region

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AG-8191-S-16-0002.pdf PDF
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Forestwide Road Maintenance Solicitation No. AG-8191-S-15-0022 Attachment 7

SOURCE SELECTION SENSITIVE WHEN COMPLETED

**NOT TO BE RELEASED OUTSIDE GOVERNMENT CHANNELS**

PAST PERFORMANCE QUESTIONNAIRE

US Department of Agriculture, US Forest Service, Region 3 – Western Zone Contracting Prescott National Forest is considering the firm listed below. Your comments would be appreciated regarding this firm’s past performance.

Past Performance Information:

Name and Address of Firm Being Evaluated: _

_
_
Contract No.:Type of Contract:_ Project Title:_
Date of Award:_ Completion Date:_ Location:

Initial Amount: _ Final Amount: _ Description:

Evaluator: (The following information will assist in the analysis of the data)

Name of Evaluator: ____ Company/Agency Name: _ Address:

Phone Number: _ Email Address: _ Position Held or Function in Relation to Project:

Rating: If the rating is “Unacceptable”, please provide additional information in the appropriate block or in the remarks section of this form.

“O”OutstandingPerformance greatly exceeded the contract requirements. “G”GoodPerformance exceeded the contract requirements.
“A”AcceptablePerformance met the contract requirements.
“M”MarginalPerformance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory.
“U”UnacceptablePerformance was poor and/or did not satisfy contract requirements.

Please circle the appropriate rating and provide any supporting information for the following:

1
The relationship between the firm and client’s/customer’s contract team:
O G A M U N/A
2
The firm’s management and coordination of subcontractors/consultants:
O G A M U N/A
3
Overall corporate management, integrity, reasonableness and cooperative

conduct:

O G A M U N/A

4
Timeliness and quality of reports, deliverables, and other required submittals and

documents:

O G A M U N/A

5
The firm’s business integrity:
O G A M U N/A
6
Responsiveness to client/customer’s requirements:
O G A M U N/A
7
Ability to control costs and provide the required work at a reasonable total price:
O G A M U N/A
8
Contract Compliance:
O G A M U N/A
9
Contract Management:
O G A M U N/A
10
Compliance with safety standards and/or number of safety related incidents, code

compliance, as applicable:

O G A M U N/A

11
Performance of Public Relations related to construction:
O G A M U N/A
12
Quality Control Procedures:
O G A M U N/A
13
Construction and installation of asphalt roadways:
O G A M U N/A
14
Construction and installation of water systems:
O G A M U N/A
15
Construction and installation of wastewater systems:
O G A M U N/A
16
Performance of trailhead and trail construction:
O G A M U N/A
17
Installation of electrical systems:
O G A M U N/A
18
Performance of campground and/or picnic area reconstruction:
O G A M U N/A
19
Construction of bridges:
O G A M U N/A
20
Construction of concrete and aggregate pathways:
O G A M U N/A
21
Have any cure notices, show cause letters, letter of reprimand, suspension of

payment, or termination been issued? If yes please explain:

Yes No

22
Would you award another contract to the firm being evaluated: If no, please

explain:

Yes No

23
Was the customer satisfied with the end product? If no, please explain:
YesNo
24
Has the firm being evaluated been provided an opportunity to discuss or respond

to any negative comments or performance ratings? If so, what were the results?

Yes No

25
Additional Remarks:
26
Overall rating for this firm:
O G A M U N/A

Printed Name of Evaluator

Signature of Evaluator Date

This questionnaire should be submitted to the US Forest Service via email to Joni Dutcher at jdutcher@fs.fed.us.

File details come from the government source that posted it. Updated .