Attachment Contractor Past Performance Questionaire.doc

AG-94TZ-S-12-0018

Contractor Past Performance Inquiry

INFORMATION/CONFIDENTIAL

Coconino Janitorial AG-94TZ-S-12-0018 Dear Customer:

Our firm has submitted a quote to the USDA Forest Service, Region 3, Western Zone AQM. In accordance with the Federal Acquisition Regulations (FAR), they will evaluate our firm’s past performance. Your firm has been listed as a reference for work previously performed.

Your candid response to the attached survey will assist the evaluation team in this process and your participation in this evaluation is greatly appreciated. Please complete the enclosed survey as thoroughly as possible. General information regarding the responses may be released to the quoter; the FAR prohibits the release of names providing the responses. Complete confidentiality will be maintained.

Please send the completed form to the address below to arrive NO LATER THAN 3/23/2012 or the closing date of the solicitation, whichever is later:

DO NOT RETURN THIS FORM TO OUR COMPANY, PLEASE RETURN TO:

USDA Forest Service

R3 Western Zone AQM 2324 E. McDowell Rd.

Phoenix, AZ 85006-2440 Attn: Michael Carico, CO Or email it to: mcarico@fs.fed.us Contractor Name:

Address:

Contract or Order No.

Total Value of Contract:

Liquidated Damages Assessed:

Contract Award Date:

Final Completion Date:

Name of person completing this form:

Phone Number:

Name of Company or Government Agency:

Description of work this company performed:

RATINGS - Summarize contractor performance and check the number that corresponds to the rating for each category.

CUSTOMER SATISFACTION

Was the project completed in accordance with the contract specifications?

How well did the contractor identify and correct deficient work?

Were submittals, testing, certifications, and final drawings (as-builts) completed accurately and timely?

Was work performed as scheduled?

Were delays resolved quickly and to both parties satisfaction?

QUALITY OF SERVICES

Did the contractor provide adequate oversight to sub-contractors, suppliers, employees?

Did the contractor maintain a good relationship with the owner, contracting agency, and management personnel?

If there were change orders, was the contractor reasonable in defining scope of change and controlling cost?

Did the contractor provide adequate work force (number and skills) for work being performed?

How well did the contractor manage the quality of work?

SOURCE SELECTION INFORMATION/CONFIDENTIAL

TIMELINESS

Did the contractor complete the project on time?

If there were problems,were they addressed and resolved?

CUSTOMER SATISFACTION

Would you recommend the selection of this contractor again?

SOURCE SELECTION INFORMATION/CONFIDENTIAL

Comments:

PAGE