Attachment 04 - past performance questionnaire.docx

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Technical and Programmatic Support Services (TPSS) III IDIQ MATOC
Solicitation number
PANHES-24-P-0000-003867
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Written by GovTribe AI ·

This is a Past Performance Questionnaire template designed to collect references from previous clients regarding a contractor's performance on relevant contracts. The questionnaire is structured in two main sections: Section A captures contract details including company information, contract specifics (title, number, type, award date, original and final prices), scope of work performed, and timeline information. Section B contains a comprehensive evaluation framework across five performance categories rated on a five-point scale from Unsatisfactory to Excellent.

The evaluation categories assess: (1) Quality of Work, including safety compliance, labor standards adherence, quality control efforts, and customer satisfaction commitment; (2) Cost Controls, covering the contractor's ability to perform at contract price, submit fair proposals for additional work, and maintain competitive pricing on indefinite delivery contracts; (3) Timeliness of Performance, evaluating submission timeliness, responsiveness to requests, on-time completion, liquidated damages assessment, and performance exceeding contractual requirements; (4) Effectiveness of Management, addressing subcontract award and management capabilities, small business participation goals, personnel qualifications, and performance ratings for specific roles (Program Manager, Project Manager, Engineering/Technical staff, Quality Control Manager, Safety Officer, and Superintendent); and (5) Customer Satisfaction, assessing contractor cooperation and customer focus. The questionnaire concludes with an overall contractor rating and contact information for the reference respondent. Completed questionnaires are to be returned via instructions provided in the RFP, with provisions for completion of Section A only if the referenced party does not respond.

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Attachment 02 Element 2 - Sample TO info 5 Aug 26.docx DOCX document
Exhibit A CDRLS TPSS 3 MATOC 5 Aug 26.zip ZIP file
Attachment 01 PWS TPSS III MATOC - 30 Jul 2026.docx DOCX document
Attachment 05 Individual Subcontracting Plan Template V2.1 June 2025.docx DOCX document
Attachment 03 Design Template.docx DOCX document
RFP TPSS III MATOC W912DY27RA014 7 Aug 2026.docx DOCX document

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PAST PERFORMANCE QUESTIONNAIRE

Please return this completed Questionnaire via instructions provided in the RFP. In the event you do not get a response from the requested party, please complete Section A and return with you proposal. Thank you for your assistance.

SECTION A: PAST PERFORMANCE QUESTIONNAIRE

Company/Agency Name

Address

Person Completing Survey

Date Survey Completed

Position Held in Reference to the Contract

Length of Involvement in Contract

Email Address

Telephone Number

Fax Number

Contractor

Contract Title

Contract Number

Project Description

Contract Type/Cost

Award Date

Original Contract Price

Final Contract Price

Explain Difference

Percentage of Work Performed by Contractor

Roles and Responsibilities as Sub or Prime

Expected Completion Date

Actual Completion Date

Explain Differences

(Presented for Information Only – Not to be completed by Offeror) Section B

1. Quality of Work:

a)How would you rate the contractor’s compliance with applicable safety standards to protect personnel and company/agency resources?
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent
b)How would you rate the contractor’s compliance with applicable labor standards?
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent
c)How would you rank the contractor’s effort in Quality Control in ensuring quality workmanship on your project?
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent
d)How would you rate the contractor’s commitment throughout the project to customer satisfaction?
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent
e)How would you rate the contractor for their overall Quality of Work?
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent

2. Cost Controls:

a)How would you rate the Contractor’s ability to perform the required services at the contract price without adverse effect on performance?
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent
b)How would you rate the contractor’s ability to submit a fair and reasonable proposal when requested to perform additional work?
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent
c)If this contract is an indefinite delivery type contract (e.g., Multiple Award Environmental Contract, Task Order Contract, etc.), has the Contractor submitted competitive quotes on the individual orders issued under this contract?
|_| Yes|_| No|_| N/A
d)How would you rate the contractor for their overall ability to maintain Cost Controls throughout the project?
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent

3. Timeliness of Performance:

a)How would you rate the contractor’s timeliness in submitting schedules, reports, billings and other contract submittals?
|_| Always|_| Usually|_| Sometimes|_| Never|_| N/A
b)How would you rate the contractor’s timeliness in responding to requests for proposals for additional work?
|_| Always|_| Usually|_| Sometimes|_| Never|_| N/A
c)Did the contractor complete the contract on time taking into account all excusable delays?
|_| Yes|_| No|_| N/A
d)Was the contractor assessed any liquidated damages or deductions for late or nonperformance of required work? If yes, please explain.
|_| Yes|_| No
e)Did the contractor exceed contractual requirements in relation to Timeliness of Performance in a way that was deemed beneficial to your agency?
|_| Yes|_| No|_| N/A
If you answered No, indicate your reason by checking one of the following:
|_| Contractor met the requirements, but did not exceed them
|_| Did not meet some of the requirements
|_| Did not meet requirements and recovery is not likely
f)How would you rate the contractor’s overall Timeliness of Performance?
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent

4. Effectiveness of Management:

a)How would you rate the contractor’s ability to award subcontracts in a timely manner and properly manage them?
|_| Always|_| Usually|_| Sometimes|_| Never|_| N/A
b)If applicable, did the contractor meet its small, small disadvantaged and women-owned business participation goals?
|_| Yes|_| No|_| N/A
c)How would you rate the management of this firm as it relates to the completion of your contract and to the qualifications of its on-site personnel. Please explain.
|_| Unsatisfactory|_| Marginal|_| Satisfactory|_| Very Good|_| Excellent
d)Describe the performance of the following personnel (if applicable)
1. Program Manger|_| U|_| M|_| S|_| VG|_| E
2. Project Manager|_| U|_| M|_| S|_| VG|_| E
3. Engineering/Technical|_| U|_| M|_| S|_| VG|_| E
4. Quality Control Manager|_| U|_| M|_| S|_| VG|_| E
5. Safety Officer|_| U|_| M|_| S|_| VG|_| E
6. Superintendent|_| U|_| M|_| S|_| VG|_| E

5. Customer Satisfaction:

a)Did the Contractor show reasonable and cooperative behavior and attention to customer satisfaction?
|_| Yes|_| No|_| N/A
If you answered NO, please explain why:

6. Overall Rating of Contractor:

In summary, which of the following would you choose to best describe the overall quality of this firm’s past performance?

|_| Unsatisfactory |_| Marginal |_| Satisfactory |_| Very Good |_| Excellent

7. Contact Information Name of Person Completing Form

Position
Project Description
Role of Contractor
Phone No.

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