Attachment 3 Past Performance Questionnaire.docx
DOCX document 16 KB Posted
- Attached to
- Grindstone Finish Tank and Pumps
- Solicitation number
- 75H70123R00042
About this file
This document contains a solicitation notice for a construction project for the Indian Health Service. The project involves installing a 10,000 gallon water storage tank, a new booster station and associated controls, replacement of two well pumps, installation of fencing and electrical work, and training at the Grindstone Indian Rancheria in Elk Creek, California. The period of performance is 180 calendar days with a project magnitude between $250,000 and $500,000. The solicitation will be procured as a total small business set-aside and awarded as a firm fixed price contract under NAICS code 237110. Proposals are due by the date and time listed in block 13 of the SF1442 and will be evaluated based on lowest price technically acceptable. Questions should be submitted to the listed contract specialist and registration in SAM is required to be considered for award.
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Text version
PAST PERFORMANCE QUESTIONNAIRE
Instructions to client:
The contractor is proposing for a construction contract with Indian Health Service https://www.ihs.gov/ You are requested to complete this form, sign, and return it to the contractor so it may be submitted with their proposal.
PART I CONTRACT INFORMATION (Contractor to complete)
Contractor Name:
Project Title
Award Value
Period of Performance
| Prime Contractor or Subcontractor |
| ☐ Prime ☐ Subcontractor |
Agency or Entity Name and Address
PART II PERFORMANCE INFORMATION (Client to complete)
Name / Title
Phone #
Email Address
Contract Type
Signature
Instructions: Please select the adjective rating that best reflects your evaluation of the contractor’s performance. See Part III for rating guidance.
| Category |
| Exceptional |
| Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Quality
Schedule
Cost Control
Management
Small Business
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Regulatory Compliance | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Comments (expand as needed) |
PART III RATING GUIDANCE
| RATING |
| DEFINITION |
| NOTE |
| (E) Exceptional |
| Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective. |
| An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified. |
| (G) Good |
| Performance meets contractual requirements and exceeds some to the Government’s/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| A Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been no significant weaknesses identified. |
| (S) Satisfactory |
| Performance meets minimum 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. |
| A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract. There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract. |
| (M) Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed 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. |
| A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner. |
| (U) 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 serious problem(s) for which the contractor's corrective actions appear or were ineffective. |
| An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating. |
| (N) Not Applicable |
| No information or did not apply to your contract |
| Rating will be neither positive nor negative. |
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