Attachment 7 - Specialized Experience Questionnaire.pdf

Specialized Experience Questionnaire

1. Contractor Information

UEI Number:

Firm Name:

Address:

Point of Contact:

Phone Number:

Email Address:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain)

Percent of project work performed:

If subcontractor, who was the prime (Name/Phone/Email:):

3.Contract Information

Contract Number: Delivery/Task Order Number (if applicable):

Contract Title:

Contract Location:

Award Date:

Contract Completion Date:

Contract Price:

4. Project Description: (Describe how this project is relevant to the NWS sterile insect dispersal or air trasnportation requirement. Include details such as similar aircraft, crews/personnel qualifications, requirements, conditions, etc. Attach additional pages if necessary.)

Part B: CLIENT INFORMATION (Client to complete questions 5-7 and page 2 of this Questionnaire)

5. Client Information Firm/Agency Name:

Name (individual completing this form):

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Client’s Signature: __________________________________ Date: __________________________________

Part A: CONTRACT INFORMATION (Contractor to complete questions 1-4)

Project Experience Questionnaire (Part B continued)

RATING SCALE:

(E) Exceptional Performance met contractual requirements and exceeded many to the Government/Owner’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

(VG) Very Good Performance met contractual requirements and exceeded some of the Government's/Owner's benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

(S) Satisfactory Performance met minimum contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

(M) Marginal Performance did not meet some contractual requirements. The contractual performance reflected 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.

(U) Unsatisfactory Performance did not meet most contractual requirements and recovery was not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

(N) Not applicable No information or did not apply to your contract.

TO BE COMPLETED BY CLIENT: Using the definitions above, please circle the adjective rating which best reflects your evaluation of the contractor's performance.

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

E VG S M U N

1. Rate the contractor's compliance with contractual requirements

2. Ability to meet quality standards specified for technical performance

3. Timeliness/effectiveness of contract resolution without extensive customer guidance

4. Adequacy/effectiveness of quality control and adherance to contract quality assurance

5. Rate the contractor's ability to provide a qualified workforce to this effort

6. Rate the contractor's ability to provide sufficient equipment (aircraft) resources to this effort

7. Rate the contractor's on-site management, including management of personnel/ crews and equipment (includes management of subcontractors)

8. Ability to manage and supervise services performed at the work location

9. To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

10. Rate the overall extent the contractor maintained an environment of safety

11. Provide an overall rating for the work performed by this contractor

12. Additional Remarks (attach additional pages if necessary)