Past_Performance_Questionnaire.pdf

Prescott Airport Improvements Solicitation No. AG-8371-S-15-0003

SOURCE SELECTION SENSITIVE WHEN COMPLETED

**NOT TO BE RELEASED OUTSIDE GOVERNMENT CHANNELS**

PAST PERFORMANCE QUESTIONNAIRE

US Department of Agriculture, US Forest Service, Region 3 – 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” Outstanding Performance greatly exceeded the contract requirements.

“G” Good Performance exceeded the contract requirements.

“A” Acceptable Performance met the contract requirements.

“M” Marginal Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory.

“U” Unacceptable Performance 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 of airport taxiways: O G A M U N/A 16 Construction of paving and concrete work on airport: O G A M U N/A 17 Performance with multiple contracting entities: O G A M U N/A 18 Performance of contracts with City and Federal entities: O G A M U N/A 19 Construction of airport lighting: 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: Yes No

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 Jamie Wade at jlwade@fs.fed.us no later than April 16, 2015 @ 4:30 PM local time.