Attach5-Past_Performance_Questionnaire.docx
DOCX document 38 KB Posted
- Attached to
- ROAD PAVING IDIQ COCONINO AND KAIBAB NF
- Solicitation number
- AG-94TZ-S-16-0048
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PAST PERFORMANCE QUESTIONAIRE
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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 Tonto 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 |
| Road Maintenance & Construction, Indefinite Delivery Indefinite Quantity (IDIQ) | AG-94TZ-S-16-0048 | |
| Coconino & Kaibab National Forests | ATTACHMENT 5 |
| 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 |
| O G A M U N/A |
| 12 |
| Quality Control Procedures: |
| O G A M U N/A |
| 13 |
| Road grading quality |
| O G A M U N/A |
| 14 |
| Road grading on unimproved roads |
| O G A M U N/A |
| 15 |
| Culvert/cattleguard cleaning |
| O G A M U N/A |
| 16 |
| Have any cure notices, show cause letters, letter of reprimand, suspension of |
payment, or termination been issued? If yes please explain:
Yes No
| 17 |
| Would you award another contract to the firm being evaluated: If no, please |
explain:
Yes No
| 18 | |
| Was the customer satisfied with the end product? If no, please explain: | |
| Yes | No |
| 19 |
| 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
| 20 |
| Additional Remarks: |
| 21 |
| 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 Michael Carico at mcarico@fs.fed.us, by Aug 11, 2016.
File details come from the government source that posted it. Updated .