Attachment 2 -Past Performance Questionnaire.doc

RFQ #2031JW23Q00060

Attachment 2 – Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

NAME OF THE CONTRACTOR REQUESTING THE REFERENCE: _________________

The purpose of this questionnaire is to obtain information regarding the quality of the above named Contractor’s past performance relative to a contract, completed or in progress, at your company/agency. The Office of the Comptroller of the Currency (OCC) is considering this Contractor to oversee the OCC’s conference center, conference room set ups, catering, multi-purpose room, vending, and pantries.

We would greatly appreciate your input regarding the quality of the Contractor’s past performance.

Handwritten responses are sufficient. It is requested that only individual(s) responsible for the administrative oversight of the project (e.g. client liaison, COR, COTR, etc.) respond to this questionnaire. More than one copy of the questionnaire may be submitted if responses from more than one individual are appropriate. Please send all completed surveys, via email to Andre.adams@occ.treas.gov and Karen.green@occ.treas.gov. We appreciate your efforts on our behalf.

PROJECT TITLE AND LOCATION: _________________________________________

AWARD DATE: _________________________________________

EST/FINAL COMPLETION DATE: _________________________________________

ORIGINAL COMPLETION DATE: _________________________________________

Please provide a brief description of the scope of this project so that we determine any similarities to this contract:

II. Evaluator Information

Name _____________________________________________________________ Title ______________________________________________________________ Name of the Prime Agency/Company ___________________________________

Address ___________________________________Fax:____________________

Phone _____________________________________________________________ II. INSTRUCTIONS – For each item, circle the rating that best describes the contractor’s work on this project and provide any additional comments. For items not applicable to your project, please indicate N/A.

5= Exceptional

No problems, issues, or delays in achieving contract requirements

4= Very Good

Does not impact achievement of contract requirements

3=Acceptable

Requires minor agency resources to ensure achievement of contract requirements

2=Marginal

Requires major agency resources to ensure achievement of contract requirements

1= Unacceptable

Achievement of contract requirement is compromised

N/A= Not Applicable Does not apply

Comments:___________________________________________________________________

Comments: ____________________________________________________________________

Comments:____________________________________________________________________

N/A

Comments:____________________________________________________________________