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.Purchasing@dot.gov with a subject line of “Source Selection Information: RFQ 69056726Q000036

WA NP LARO 208(1), Hawk Creek Road Stabilization and WA FLAP LINCOL 57860(1) Hawk Creek Road Improvements

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:

mailto:WFL.Purchasing@dot.gov

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Note: When completing this questionnaire by e-mail, please do not use a color, such as red, to select the rating in section I of this questionnaire. Color fonts do not show well when printed.

Please bold it, underline it, or increase the font size in black.

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

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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

Remarks: