Attachment_5_Past_Performance_Questionnaire.docx

DOCX document 46 KB Posted

Attached to
Replace Fire System Piping, Lava Beds Nat'l Monumt Federal contract opportunity
Solicitation number
140P8426Q0013
Issued by
Department of the Interior National Park Service Pacific West Region

About this file

Written by GovTribe AI ·

This is a Past Performance Questionnaire template used for source selection evaluation in federal contracting. The questionnaire is designed to be completed collaboratively between the offeror (contractor), the selected reference, and the contracting officer for solicitation 140P8426Q0013, a National Park Service small business set-aside requiring replacement of fire suppression piping at Lava Beds National Monument.

The questionnaire is divided into five sections: Section A requests contractor information including company name, address, UEI number, and point of contact; Section B requires the contractor to provide contract details such as project title, contract number, type, awarded price, current/final price, award date, completion date, period of performance, project location, and scope of work description. Section C captures reference information including name, position, title, organization, phone, email, and signature with date. Section D contains the evaluation component, which the reference completes by rating the contractor's performance across six key areas—Quality, Schedule & Time Management, Cost Control, Management, Small Business Subcontracting & Labor Standards, and Regulatory Compliance—using a five-point scale (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory). Each evaluation area includes specific assessment criteria and space for supporting comments. Section E specifies the return deadline of 4:00 p.m. Pacific Daylight Time on September 16, 2026, and provides contracting officer contact information: Phaedra Fuller at the Department of the Interior, National Park Service - Point Reyes Major Acquisition Buying Office.

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Sol_140P8426Q0013.pdf PDF
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Solicitation: 140P8426Q0013 Offeror Company Name: _________________________________

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS: Offeror to complete Sections A and B and transmit questionnaire to reference.

Reference to complete Sections C and D and transmit back to Contracting Officer listed in section E.

Notice to Contractor

Information provided in this questionnaire is intended for use as source selection information and as such is deemed Source Selection Sensitive. Statements or comments provided in the questionnaire do not signify an express or implied endorsement of any product, supply, service, or enterprise.

This information shall not be construed as an endorsement by the Government or its employee(s) of the contractor for advertising purposes or in a manner that implies the contractor, its products, or services, are approved, endorsed, or considered by the Government to be superior to other products or services.

The contractor shall not be permitted to use any information provided in this questionnaire to publicize, or otherwise circulate, promotional materials that state or imply Governmental, organizational, group, expert, or individual endorsement or consumer testimonial of a product, service, or position which the contractor represents.

A. CONTRACTOR INFORMATION (check one) ☐company listed above ☐ proposed sub for company listed above

Company Name
Company
Street Address
Address
City
City
State
State
Zip Code
XXXXX
UEI Number
XXXXXXX
Point of Contact
Name, Email, Phone

B. CONTRACT INFORMATION

Project Title
Title
Contract Number
XXXXXXXXXX
Contract Type
Firm Fixed Price / Time & Materials / Cost Reimbursable / Other
Awarded Contract Price
$X,XXX,XXX
Current / Final Price
$X,XXX,XXX
Contract Award Date
XX/XX/XXXX
Contract Completion Date
XX/XX/XXXX
Period of Performance
XX/XX/XXX – XX/XX/XXX
Project Location
Park or Street address, City, State
Client / Owner
Company
Brief description of the contract & work effort:
Scope of work description

C. REFERENCE:

Name
First, Last
Position / Title
Title
Organization
Agency or Company
Phone Number
XXX-XXX-XXXX
Email Address
Email
Signature
Signature
Date
XX/XX/XXXX

D. EVALUATION

Rating
Definition
Exceptional
Performance met contractual requirements and exceeded many to the owner’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
Very Good
Performance met contractual requirements and exceeded some to the owner’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
Satisfactory
Performance met contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
Marginal
Performance did not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.
Unsatisfactory
Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.
Evaluation Area
Rating

Quality

Quality of workmanship (including subcontractors)?
Choose an item.
Quality of and adherence to quality control plan?
Choose an item.
Quality of informational and technical submittals?
Choose an item.
Overall Quality Rating
Choose an item.
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Schedule (& Time Management)

Met project schedule milestones?
Choose an item.
Responded to owner requests in a timely manner?
Choose an item.
Informational and technical submittals submitted timely?
Choose an item.
Promptly addressed scheduling issues?
Choose an item.
Overall Schedule (& Time Management) Rating
Choose an item.
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Cost Control

Addressed differing & unforeseen site conditions so as to minimize additional costs?
Choose an item.
Provided fair and reasonable pricing for contract modifications?
Choose an item.
Submitted accurate and complete invoices?
Choose an item.
Promptly paid subcontractors and suppliers?
Choose an item.
Overall Cost Control Rating
Choose an item.
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Management

General oversight by project manager and superintendent?
Choose an item.
Coordination with and control of subcontractors?
Choose an item.
Avoidance of accidents & safety violations?
Choose an item.
Addressed location factors (especially remote locations)?
Choose an item.
Maintained good working relationship with owner representatives?
Choose an item.
Demonstrated flexibility, innovativeness and cooperation in resolving potential problems?
Choose an item.
Overall Management Rating
Choose an item.
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Small Business Subcontracting (& Labor Standards)

Met regulatory and contractual labor standards?
Choose an item.
Successfully contracted with small and socio-economically disadvantaged businesses?
Choose an item.
Quality and adherence to applicable subcontracting plans?
Choose an item.
Overall Small Business Subcontracting (& Labor Standards) Rating
Choose an item.
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Regulatory Compliance

Met building and life safety codes?
Choose an item.
Overall Regulatory Compliance Rating
Choose an item.
Overall Recommendation:
Given what I know today about the contractor's ability to perform in accordance with the contract’s most significant requirements, I would recommend them for similar contracts:
Choose an item.
Overall Comments:

E. RETURN:

Return by
4:00 p.m. Pacific Daylight Time on September 16, 2026
Name
Phaedra Fuller
Title
Contracting Officer
Organization
Department of the Interior, for the National Park Service – Point Reyes Major Acquisition Buying Office (PORE MABO)
Email
phaedra_fuller@ios.doi.gov

File details come from the government source that posted it. Updated .