Attachment 5_Past Performance.docx

ATTACHMENT 5 – PAST PERFORMANCE QUESTIONNAIRE – Non USFS Performance

PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection for 1202SA23R9101 Aerial Supervision Module (ASM) Aircraft Services Response Date: TBD Please complete this Questionnaire and email to: amelia.velasco@usda.gov

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

Address:

DUNs Number:

Phone Number: Email Address: Point of Contact:

Contact Phone Number:

2. Work Performed as:

Prime Contractor

Sub Contractor

Joint Venture

Other (Explain)

Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify): Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE OR HIGHLIGHT THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

QUALITY

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance)

E

VG

S

M

U

N

SCHEDULE/TIMELINESS OF PERFORMANCE

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please

E

VG

S

M

U

N

CUSTOMER SATISFACTION

b) Reasonableness and cooperativeness in regard to working with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication)

E

VG

S

M

U

N

MANAGEMENT/ PERSONNEL/LABOR

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):