Past_Performance_Questionnaire.doc
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- North Kaibab Janitorial
- Solicitation number
- AG-94TZ-S-17-0301
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Past Performance Questionnaire
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Past Performance Questionnaire 1.
CONTRACT INFORMATION
| Contractor: |
| Contract No.: |
| Contract Type |
| Negotiated |
Sealed Bid
Competitive
Non-Competitive
Firm, Fixed Price
Cost Type
| Period of Performance |
| From: |
To:
Initial $ Value
Final $ Value
Brief Contract Description:
| Complexity: |
| Difficult |
Moderate
Routine
2.
RATER INFORMATION
Please provide the information requested below to assist USDA Forest Service in evaluating past performance of prospective service providers.
Name:
Company/Organization:
Position Title
Telephone/Fax Nos.:
Mailing Address:
Length of Time Involved with the Contract
Questionnaire Completion Date
3.
GENERAL INFORMATION
Please answer the following questions:
A. Has the Contractor even been given a cure notice, show cause notice, suspension of progress payments, etc.?
Yes
No
If yes, please explain:
B. Has this contract been partially or completely terminated?
Yes
No
Reason:
Default
Convenience
If yes, please explain:
4.
RATING PAST PERFORMANCE
Please rate the statements below as they relate to the contractor’s performance in each category. If a ‘Poor’ or ‘Unacceptable’ rating is given, please discuss in the section provided at the end of the rating section. If a statement is not applicable, indicate ‘Not Applicable.”
The definitions for rating the statements in section 4.1 are provided below:
| EXCELLENT |
| GOOD |
| FAIR |
| POOR |
UNSATISFACTORY
| All performance requirements were enhanced or exceeded. operational requirements met or exceeded. |
| All performance requirements were met; all operational requirements were met. |
| Most performance requirements were met; most operational requirements are met; some customer was intervention required. |
| Some performance requirements were met; some operational requirements were met; substantial customer intervention required. |
| Non-conformances compromise the program severely despite substantive intervention by the customer. |
4.2. Past Performance that demonstrates recent relevant past performance of projects that are comparable in size and scope to that as listed in the PWS and demonstrates customer satisfaction and timeliness.
42.1. Was the past performance based on projects that are comparable in size and scope to that as listed in the PWS? If no, why not?
4.2.2 Did the services meet contractual requirements, particularly with respect to the quality provided? If no, why not?
4.2.3 Was the Service Provider cooperative and responsive in a timely manner to your needs? If no, why not?
4.3 Please Discuss any Poor or Unsatisfactory Past Performance Ratings:
5.
CONCLUSION
Based on this Contractor's overall performance, would you award them another contract?
Yes
No
If no, please explain.
The undersigned hereby confirms that the information provided in this document is correct as written. Should any corrections be required, the undersigned shall contact the Contracting Officer not later than 7 calendar days after the date of the signature below. This confirmation shall allow the agency to use the information contained herein as source selection information.
Signature
Date
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