Attachment 0004_Past Perf Questionnaire.pdf

Attachment 0004 Page 1 of 3

Past Performance Questionnaire Please return the completed questionnaire via e-mail to WFL.Contracts@dot.gov with a subject line of “Source Selection Information: WFLHD Building Renovation Project “

Evaluation Factor Rating System. Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings:

N/A=Not Applicable U=Unsatisfactory M=Marginal S=Satisfactory VG=Very Good E=Exceptional

• Unsatisfactory - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

• Marginal - Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

• Satisfactory - Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

• Very Good - Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

• Exceptional – Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

For ratings of “Marginal” and/or “Unsatisfactory”, please provide a brief explanation in the remarks section.

Name of Rated Company:

Project Name:

Submitted by: Phone:

Email:

Agency:

Attachment 0004 Page 2 of 3

Please return the completed questionnaire via e-mail to WFL.Contracts@dot.gov with a subject line of “Source Selection Information: WFLHD Building Renovation Project “

Technical (quality of product or service) How would you rate the quality of the Contractor’s technical abilities and/or workmanship to provide the required supplies and/or services?

N/A U M S VG E

How would you rate the ability of the contractor to work within an environmentally sensitive area? N/A U M S VG E

Schedule/Timeliness How would you rate the contractor’s adherence to the approved schedule? N/A U M S VG E How would you rate the ability of the contractor to provide the right equipment and material to perform the required work?

N/A U M S VG E

Cost control (not applicable for firm-fixed-price or fixed-price with economic price adjustment arrangements).

How would you rate the contractor’s ability and effectiveness managing and controlling costs within the confine of the contract?

N/A U M S VG E

Management Did the contractor’s QC program effectively monitor all work? N/A U M S VG E Did the contractor complete work in accordance with the specifications? N/A U M S VG E How would you rate the contractor’s ability to promptly resolve problems? N/A U M S VG E How would you rate the Contractor’s ability to effectively manage, coordinate, and integrate subcontractors N/A U M S VG E

Small Business Contracting How would you rate the Contractor’s ability to demonstrate a good faith effort to meet all subcontracting goals in the various socio-economic categories?

N/A U M S VG E

How would you rate the Contractor’s ability to utilize Small Business concerns and met any other small business participation requirements included in the contract/order?

N/A U M S VG E

Regulatory Compliance How would you the contractor’s compliance with applicable laws, regulations, and contract requirements? N/A U M S VG E

Other:

Customer Satisfaction: Was the Contractor committed to customer satisfaction? Yes No N/A

Safety: Was the Contractor committed to running a safe operation? Yes No N/A

Recommendation: Would you recommend the Contractor for similar requirements in the future? Yes No

Attachment 0004

Please return the completed questionnaire via e-mail to WFL.Contracts@dot.gov with a subject line of “Source Selection Information: WFLHD Building Renovation Project “

Remarks: