Attachment 6 - Past Performance Questionnaire.pdf
PDF 135 KB Posted
- Attached to
- PKA B665 REPAIR WASTEWATER PIPES
- Solicitation number
- FA442725R0017
About this file
The document is a Past Performance Questionnaire, a standardized form used to evaluate a contractor's performance on previous government contracts. The questionnaire provides a detailed rating system with five performance levels: Exceptional, Very Good, Satisfactory, Marginal, and Unsatisfactory, covering six key assessment areas including Quality, Schedule, Cost Control, Management, Small Business, and Regulatory performance. The form requires specific details about the contract, such as contract number and value, and allows the evaluator to provide a rating and accompanying justification for each performance category, with space for additional remarks and respondent contact information.
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Text version
PAST PERFORMANCE QUESTIONNAIRE
1. Reference Information:
Contract Number (Include task order number(s)) if applicable:
Contract Value:
Contractor performed as: Prime Contractor Sub-Contractor
2. Description of Work Completed:
3. Contractor Performance Assessment Reporting Rating:
Below please provide a rating based on the following table to rate the contractor’s performance.
Exceptional Performance meets contractual requirements and exceeds many to the Government’s benefit.
The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
Very Good Performance meets contractual requirements and exceeds some to the Government’s benefit.
The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
Satisfactory Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.
Unsatisfactory Performance does not meet most contractual requirements, and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.
Note: Ratings other than a satisfactory rating should include accompanying rationale to justify the higher or lower rating.
3.1: Quality Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.2: Schedule Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.3: Cost Control Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.4: Management Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.5: Small Business Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
3.6: Regulatory Rating:
Exceptional Very Good Satisfactory Marginal Unsatisfactory
Justification for rating:
Additional Remarks:
Respondents Signature Name:
Email:
Phone Number:
Agency/Company:
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