Attachment_5_-_Past_Performance_Questionnaire.pdf
PDF 192 KB Posted
- Attached to
- GAOA SOUTH PRYOR ROADS
- Solicitation number
- 140L3626R0001
About this file
This is a Performance Questionnaire designed to evaluate contractor performance on federal contracts. The document is structured as a two-part form: one section for offerors to provide contract information and another section for evaluating organization representatives to assess contractor performance.
The offeror section requests basic contract details including contractor name and address, contract number, initiation and completion dates, contract value with options, contract type (identified as Fixed Price in the template example), and a description of contract requirements. The evaluating organization representative section requires the evaluator's name, position (Project Manager, Contracting Officer's Representative, or other), organization, phone number, and the duration of performance monitoring in months. The questionnaire uses a standardized rating scale with five response codes: N (Neutral), O (Outstanding), B (Better), A (Acceptable), and U (Unacceptable). Evaluators must rate contractors on seven topics: Quality of Products and Services, Performance, Technical Requirements, Schedule, Cost Control, Customer Satisfaction, and Overall Assessment. The form includes space for general comments. Responses must be submitted to Jalvarez@blm.gov no later than September 8, 2025. This questionnaire pertains to contract 140L3625R0012 for the GAOA Chain of Lakes Potable Water System Replacement and is intended to support source selection decisions for future federal contracting opportunities.
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Text version
PERFORMANCE QUESTIONNAIRE
140L3625R0012: GAOA Chain of Lakes Potable Water System Replacement
Your assistance is requested in support of a source selection. Please be aware that the procurement office must receive them by the response date below.
Please complete this Questionnaire and email to: Jalvarez@blm.gov
Response Date: Not Later Than 8 September 2025
TO BE COMPLETED BY OFFEROR
1. CONTRACTOR NAME & ADDRESS 2. CONTRACT NO.:
3. CONTRACT INITIATION DATE:
4. COMPLETION DATE:
1a: NAME OF PRIME CONTRACTOR: 5. CONTRACT VALUE (with options): $
6. TYPE OF CONTRACT (fixed price, CMP, FPI, etc.):
7. DESCRIPTION OF CONTRACT REQUIREMENTS:
TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE
8. EVALUATION:
a. Evaluator name, position (Project Manager/COR/Other) and organization:
b. Evaluator's Phone Number:
c. Months Performance Monitored by Evaluator:
Please circle response code for each topic (A-G) that best reflects your experience with this contractor.
N = Neutral O= Outstanding B = Better A = Acceptable U = Unacceptable
A. Quality of Products and Services - Assess the contractor's conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards.
N O B A U
B. Performance - Assess the contractor's performance as the General Contractor or Architect/Engineer (as appropriate) for the project.
N O B A U
C. Technical Requirements - Assess the contractor's ability to fulfill the technical requirements of the contract.
N O B A U
D. Schedule - Assess the timeliness of the contractor against the schedule of activities.
N O B A U
E. Cost Control - Assess the contractor's ability to manage the contract budget and control costs.
N O B A U
F. Customer Satisfaction - Assess the contractor's responsiveness to customer concerns and "user friendliness".
N O B A U
G. Overall Assessment
N O B A U
General Comments:
| General Comments: |
| 1: |
| Contractor Name & Address: |
| 1a: |
| Name of Prime Contractor: |
| 2: |
| Contract No: |
| 3: |
| Contract Initiation Date: |
| 4: |
| Completion Date: |
| 5: |
| Contract Value: |
| 6: |
| Type of Contract: Fixed Price |
| 7: |
| Description of Contract Requirements: |
| 8a: |
| Evaluator name, position and organization: |
| 8b: |
| Evaluator's phone number: |
| 8c: |
| Months Performance Monitored by Evaluator: |
File details come from the government source that posted it. Updated .