Attachment 7 Past Performance Questionnaire.docx
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- Solicitation number
- 12444123R0014
- Issued by
-
Department of Agriculture Forest Service
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Attachment 7 Solicitation # 12444123R0014
PAST PERFORMANCE QUESTIONNAIRE (Offeror’s clients fill out Section B of this form) E-mail this form to 3 of your past clients, have them fill out and e-mail directly to Cynthia.roberts@usda.gov
SECTION A: CONTRACTOR INFORMATION
A. Contractor’s Name and Address: _________________________________________________________
B. Point of Contact: _____________________________________________________________________
C. Phone #: ______________________________________________________________________________
D. Contract Number: ___________________________ Contract Type: _______________________________
E. Project Title: _______________________________________________________________________
F. Period of Performance: ___________________________________________________________________
G. Brief Description/Scope of Services provided: ________________________________________________
H. Authorization is hereby granted to provide the information requested in SECTION B of this questionnaire.
Signature of Offeror Date
Printed Name and Title of Offeror
SECTION B (RESPONDENT INFORMATION):
A. Name:_____________________________________________________________________________
B. Position:___________________________________________________________________________
C. Telephone Number:____________________________________ Fax Number: ___________________
D. Email Address:
E. Physical Address:____________________________________________________________________
F. Relationship and Time Involved with Contractor: ___________________________________________
G. Signature and Date Questionnaire Completed: ______________________________________________
Circle the ratings (Including Yes and No):
E
| VG |
| S |
| N |
| M |
| U |
| Excellent |
| Very Good |
| Satisfactory |
| Neutral |
| Marginal |
| Unsatisfactory |
CONTRACT PERFORMANCE
| 1. |
| Working relationship with your Company |
| E |
| VG |
| S |
| N |
| M |
| U |
| 2. |
| Did the contractor provide experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements? If no, please explain. |
| Yes |
No
N/A
| 3. |
| Exhibited knowledge of and compliance with government (or other) regulations and industry standards |
| E |
| VG |
| S |
| N |
| M |
| U |
| 4. |
| Did the contractor provide and properly maintain operational equipment throughout the term of the contract? If no, please explain. |
| Yes |
No
N/A
| 5. |
| Did the contractor demonstrate the ability to hire, maintain, and replace, if necessary qualified personnel during the contract? If no, please explain. |
| Yes |
No
N/A
| 6. |
| Does the contractor provide timely and accurate records? |
| Yes |
No
N/A
| 7. |
| How well did the contractor comply with Environmental, health and security requirements |
| E |
| VG |
| S |
| N |
| M |
| U |
| 8 |
| Would you award similar contracts to this contractor (If no, Please explain in remarks) |
| Yes |
No
N/A
| 9. |
| Contractor’s Overall Performance |
| E |
| VG |
| S |
| N |
| M |
| U |
QUALITY OF SERVICE/CONTROL
| 1. |
| Contractor’s accomplishment in meeting the quality standards |
| E |
| VG |
| S |
| N |
| M |
| U |
| 2. |
| Did the contractor provide an effective quality control plan or inspection procedures to meet contract requirements? If no, please explain. |
| Yes |
No
N/A
| 3. |
| Overall Quality of Service/Control |
| E |
| VG |
| S |
| N |
| M |
| U |
TIMELINESS OF PERFORMANCE
| 1. |
| Was the job/contract started and completed on time? If not, explain |
| Yes |
No
N/A
| 2. |
| Did the contractor have a system or method to track progress on all work in progress? |
| Yes |
No
N/A
SAFETY
| 1.. |
| How well did the contractor comply with safety requirements? |
| E |
| VG |
| S |
| N |
| M |
| U |
| 2. |
| Were there any accidents or safety infractions on the project/job site |
| Yes |
No
N/A
REMARKS: If additional remarks are necessary, please attach an additional sheet.
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