At13_140L0626R0006_Past_Perf_Questionnaire.docx
DOCX document 35 KB Posted
- Attached to
- GAOA BAR ISLAND DAM RECONSTRUCTION
- Solicitation number
- 140L0626R0006
About this file
This is a Past Performance Questionnaire template for the Bar Island Dam Reconstruction project (Contract Number 140L0626R0006), issued by the Department of the Interior Bureau of Land Management. The questionnaire is designed to collect references and performance evaluations from previous clients or project owners who have worked with contractors bidding on or performing similar work.
The form requires contractor information including company name, address, DUNS number, and point of contact details, along with contract specifics such as project title, contract type (Firm Fixed Price, Time & Materials, Cost Reimbursable, or Other), awarded price, current/final price, award date, completion date, and project location. A reference section must be completed and signed by the client/owner organization, with name, position, organization, phone number, and email required. The evaluation section assesses contractor performance across five key areas: Quality (workmanship, quality control plan adherence, and technical submittals); Schedule & Time Management (milestone achievement, responsiveness to requests, timely submittals, and scheduling issue resolution); Pricing and Payments (cost management for differing conditions, modification pricing fairness, invoice accuracy, and supplier/subcontractor payment timeliness); Management (project oversight, subcontractor coordination, safety, remote location considerations, owner relationships, and problem-solving flexibility); and Regulatory Compliance (building codes, safety codes, and labor standards). Performance ratings range from Exceptional (EX) through Very Good (VG), Satisfactory (S), Marginal (M), Unsatisfactory (U), or Not Applicable (NA), with an overall recommendation section. Completed questionnaires were due by May 25, 2020, at 2:00 PM MDT to Contracting Officer Lisa McKeon.
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Text version
PAST PERFORMANCE QUESTIONNAIRE
140L0626R0006 – BAR ISLAND DAM RECONSTRUCTION
A. CONTRACTOR INFORMATION
| Company Name |
| Company |
| Street Address |
| Address |
| City |
| City |
| State |
| State |
| Zip Code |
| XXXXX |
| DUNS Number |
| XXXXXXX |
| Point of Contact |
| Name, Email, Phone |
B. CONTRACT INFORMATION
| Project Title |
| Title |
| Contract Number |
| XXXXXXXXXX |
| Contract Type |
| Firm Fixed Price / Time & Materials / Cost Reimbursable / Other |
| Awarded Contract Price |
| $X,XXX,XXX |
| Current / Final Price |
| $X,XXX,XXX |
| Contract Award Date |
| XX/XX/XXXX |
| Contract Completion Date |
| XX/XX/XXXX |
| Project Location |
| Street address, City, State |
| Client / Owner |
| Organization/Agency/Company |
| Brief description of the contract & work effort: |
| Scope of work description |
C. REFERENCE:
Name
Position / Title
Organization
Phone Number
Email Address
| Signature |
| MUST BE SIGNED BY CLIENT/OWNER or will not be considered |
Date
D. EVALUATION
| Rating |
| Definition |
| Exceptional (EX) |
| Performance met contractual requirements and exceeded many to the owner’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| Very Good (VG) |
| Performance met contractual requirements and exceeded some to the owner’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| Satisfactory (S) |
| Performance met contractual requirements. The element being assessed contained some minor problems for which corrective actions taken by the contractor were satisfactory. |
| Marginal (M) |
| Performance did not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective action. |
| Unsatisfactory (U) |
| Performance did not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor’s corrective actions were ineffective. |
Not Applicable (NA)
The element does not pertain to the subject project as a result of specific contract and/or project requirements.
| Evaluation Area |
| Rating |
Quality
Quality of workmanship (including subcontractors)?
Quality of and adherence to quality control plan?
Quality of informational and technical submittals?
Overall Quality Rating
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):
Schedule & Time Management
Met project schedule milestones and/or deadlines?
Responded to owner requests in a timely manner?
Informational and technical submittals submitted timely?
Promptly addressed scheduling issues?
Overall Schedule & Time Management Rating
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):
Pricing and Payments
Minimized additional costs when addressing differing & unforeseen site conditions?
Provided fair and reasonable pricing for contract modifications?
Submitted accurate and complete invoices?
Promptly paid subcontractors and suppliers?
Overall Pricing and Payment Rating
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):
Management
General oversight by project manager and superintendent?
Coordination with and control of subcontractors?
Avoidance of accidents & safety violations?
Addressed location factors (especially remote locations)?
Maintained good working relationship with owner representatives?
Demonstrated flexibility, innovativeness and cooperation in resolving potential problems?
Overall Management Rating
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):
Regulatory Compliance
Met building and life safety codes?
Met regulatory and contractual labor standards?
Overall Regulatory Compliance Rating
Overall Recommendation:
Given what I know today about the contractor's ability to perform in accordance with the contract’s most significant requirements, I would recommend them for similar contracts:
Overall Comments:
E. RETURN:
| Return by |
| NLT 5/25/2020 at 2:00 pm MDT |
| Name |
| Lisa McKeon |
| Title |
| Contracting Officer |
| Organization |
| DOI Contracting Operations - Bureau of Land Management |
| lisa_mckeon@ios.goi.gov |
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