Attachment 0004 Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS: Offeror to complete Sections A and B and transmit questionnaire to reference.

Reference to complete Sections C and D and transmit back to Contracting Officer listed in section E.

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 Period of Performance XX/XX/XXX – XX/XX/XXX Project Location Park or Street address, City, State Client / Owner Company Brief description of the contract & work effort:

Scope of work description

C. REFERENCE:

Name First, Last Position / Title Title Organization Agency or Company Phone Number XXX-XXX-XXXX Email Address Email Signature Signature Date XX/XX/XXXX

D. EVALUATION

Rating Definition

Exceptional 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 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 Performance met contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal Performance did not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.

Unsatisfactory Performance does 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 appear or were ineffective.

Evaluation Area Rating Quality Quality of workmanship (including subcontractors)? Choose an item.

Quality of and adherence to quality control plan? Choose an item.

Quality of informational and technical submittals? Choose an item.

Overall Quality Rating Choose an item.

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? Choose an item.

Responded to owner requests in a timely manner? Choose an item.

Informational and technical submittals submitted timely? Choose an item.

Promptly addressed scheduling issues? Choose an item.

Overall Schedule (& Time Management) Rating Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Cost Control Addressed differing & unforeseen site conditions so as to minimize additional costs? Choose an item.

Provided fair and reasonable pricing for contract modifications? Choose an item.

Submitted accurate and complete invoices? Choose an item.

Promptly paid subcontractors and suppliers? Choose an item.

Overall Cost Control Rating Choose an item.

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? Choose an item.

Coordination with and control of subcontractors? Choose an item.

Avoidance of accidents & safety violations? Choose an item.

Addressed location factors (especially remote locations)? Choose an item.

Maintained good working relationship with owner representatives? Choose an item.

Demonstrated flexibility, innovativeness and cooperation in resolving potential problems? Choose an item.

Overall Management Rating Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Small Business Subcontracting (& Labor Standards) Met regulatory and contractual labor standards? Choose an item.

Successfully contracted with small and socio-economically disadvantaged businesses? Choose an item.

Quality and adherence to applicable subcontracting plans? Choose an item.

Overall Small Business Subcontracting (& Labor Standards) Rating Choose an item.

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? Choose an item.

Overall Regulatory Compliance Rating Choose an item.

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: Choose an item.

Overall Comments:

E. RETURN:

Return by April 9 2021 Name Scott Achin Title Contracting Officer Organization National Park Service – Interior Region 2 South Atlantic Gulf, Storm Recovery Email Scott_Achin@nps.gov