Attachment_4_-Past_Performance_Questionnaire.doc

PAST PERFORMANCE QUESTIONNAIRE PACKAGE INFORMATION AND FORMS

Replace Enginehouse Roof, Golden Spike Solicitation No. 140P1422R0007 Instructions to Offeror for sending Reference Questionnaire Forms:

Prepare and submit to the owners of the projects in which you have submitted for Prime/Sub Contractor Experience, a Past Performance Reference Package. For Government contracts, send to Contracting Officer or Technical Representative. For commercial references send to personnel with duties similar to those for Government contracts. Offerors should follow-up and encourage references to get the questionnaires to the Contracting Officer in a timely manner. If you have multiple references at one location (Park, etc.), send one cover letter and questionnaire for each contract you want a reference for. Your questionnaire package should contain the following:

· Cover Letter (See SAMPLE below) (page 1 of this document)

· Past Performance Questionnaire (pages 3 and 4 of this document)

Offeror must complete Sections I & II of the questionnaire in the spaces indicated for identification purposes, and reference must complete Sections III & IV.

· Suggested - Pre Addressed stamped envelope to return to Contracting Officer.

Please Note:

OFFEROR SHOULD PLACE HIS/HER NAME ON TOP OF EACH QUESTIONNAIRE PAGE!

OFFEROR SHOULD DELETE THESE INSTRUCTIONS BEFORE SENDING OUT QUESTIONNAIRES

SAMPLE TRANSMITTAL LETTER AND PAST PERFORMANCE QUESTIONNAIRE

Your Company Letterhead Date: _________________ To: ______________________________________

We have listed your firm as a reference for the work we have performed for you as listed below. Our firm has submitted a proposal under a project advertised by the National Park Service. In accordance with Federal Acquisition Regulations (FAR), they will evaluate our firm's past performance. Your candid response to the attached questionnaire will assist the evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible. Space is provided for comments. Understand that while the responses to this questionnaire may be released to the offeror, FAR 15.306 (e)(4) prohibits the release of the names of the persons providing the responses. Complete confidentiality will be maintained. Only one response from each office is required.

Please send your completed questionnaire via fax, email or to one of the following addresses. Questionnaires are to arrive to the National Park Service NO LATER THAN 8/23/2016. Do not return them to our company.

Email: stacy_vallie@nps.gov If you have questions regarding the attached questionnaire, or require assistance, please contact Stacy Vallie at

(307) 344-2076 or email to: Stacy_Vallie@nps.gov. Thank you for your assistance.

Signature and Title

PAST PERFORMANCE QUESTIONNAIRE

(COMPLETE SECTIONS I AND II AND SUBMIT WITH THE TECHNICAL PROPOSAL)

I. CONTRACT IDENTIFICATION

CONTRACTOR ADDRESS:

CONTRACT TYPE:

FORMCHECKBOX

FIRM-FIXED-PRICE

FORMCHECKBOX

COST REIMBURSEMENT

FORMCHECKBOX

OTHER: (specify)

FORMCHECKBOX

ACTIVE

FORMCHECKBOX

COMPLETED

FORMCHECKBOX

ROUTINE

FORMCHECKBOX

COMPLEX

DATES OF PERFORMANCE:

AWARD AMOUNT: $

TOTAL WITH MODS

PROJECT DESCRIPTION:

II. AGENCY (CUSTOMER) IDENTIFICATION

AGENCY (CUSTOMER) NAME:

POC NAME/TITLE/PHONE:

III. PAST PERFORMANCE RATING

Rating Scale:

E = Excellent. Considerably surpassed requirements/expectations.

G = Good. Surpassed requirements/expectations.

S = Satisfactory. Met requirements/expectations

M = Marginal. Met some requirements/expectations

U = Unsatisfactory. Did not meet requirements/expectations

IV. COMMENTS

Required for ratings of C (Considerably Surpassed Requirements) or D (Did Not Meet Requirements)

Solicitation No. 140P1422R0007

Past Performance Questionnaire