Attachment_5_-_Past_Performance_Questionnaire.pdf

PERFORMANCE QUESTIONNAIRE

140L3626R0002: Marcott Coulee Pipeline

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 4 September 2026

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: