Attachment_9_-_Past_Performance_Questionnaire.docx
DOCX document 31 KB Posted
- Attached to
- Remodel Golden Spike Visitor Center Federal contract opportunity
- Solicitation number
- 140P1426R0012
About this file
This is a Past Performance Questionnaire template designed for the Golden Spike Visitor Center Rehabilitation project (Solicitation #140P1426R0012) under the Department of the Interior National Park Service Intermountain Region. The questionnaire serves as a source selection evaluation tool to assess contractor performance on past and current projects.
The form is completed in two stages: contractors submit Sections A and B with their company information, project details, contract terms, and reference contacts, while selected references complete Sections C and D to provide performance ratings. References evaluate contractors across five key performance areas: Quality (workmanship, quality control adherence, and technical submittals), Schedule and Time Management (milestone achievement, responsiveness, and timeliness), Cost Control (handling of site conditions, modification pricing, invoice accuracy, and subcontractor payments), Management (oversight, coordination, safety, flexibility, and client relationships), and Small Business Subcontracting and Labor Standards compliance. Additional evaluation areas cover regulatory compliance with building and life safety codes. Each performance area uses a five-point rating scale (Exceptional, Very Good, Satisfactory, Marginal, or Unsatisfactory), with detailed definitions provided. The questionnaire also includes a yes/no overall recommendation section and requires comments supporting ratings, particularly for exceptional, marginal, or unsatisfactory assessments. Completed questionnaires must be returned by the specified deadline to Contracting Officer Stacy Vallie at the Northern Rockies Major Acquisition Buying Office.
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Text version
PAST PERFORMANCE QUESTIONNAIRE
Offeror/contractor to complete Sections A and B and transmit questionnaire to reference/client.
Reference to complete Sections C and D and transmit back to Contracting Officer listed in section E.
Notice to Contractor:
Information provided in this questionnaire is intended for use as source selection information and as such is deemed Source Selection Sensitive. Statements or comments provided in the questionnaire do not signify an express or implied endorsement of any product, supply, service, or enterprise.
This information shall not be construed as an endorsement by the Government or its employee(s) of the contractor for advertising purposes or in a manner that implies the contractor, its products, or services, are approved, endorsed, or considered by the Government to be superior to other products or services.
The contractor shall not be permitted to use any information provided in this questionnaire to publicize, or otherwise circulate, promotional materials that state or imply Governmental, organizational, group, expert, or individual endorsement or consumer testimonial of a product, service, or position which the contractor represents.
TO BE COMPLETED BY CONTRACTOR/OFFEROR:
A. CONTRACTOR INFORMATION
Offeror Name
Project Title
Project Location
Contract Number
Contract Type
Awarded Contract Price
Current / Final Price
Contract Award Date
Contract Completion Date
Period of Performance
Project Location
Client / Owner
Brief description of the contract & work effort:
Offeror’s Role:
☐ Prime Contractor ☐ Subcontractor ☐ Joint Venture Partner
B. REFERENCE INFORMATION:
Name of Reference
Street Address
City
State
Zip Code
DUNS Number
Point of Contact
Phone
TO BE COMPLETED BY REFERENCE:
C. REFERENCE:
Name
Date
Position / Title
Organization
Phone Number
Email Address
Signature
D. EVALUATION RATINGS:
| Rating |
| Definition |
| Exceptional – “E” |
| Performance met contractual requirements and exceeded many to the owner’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| Very Good – “V” |
| Performance met contractual requirements and exceeded some to the owner’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| Satisfactory – “S” |
| Performance met contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory. |
| Marginal – “M” |
| Performance did not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. |
| Unsatisfactory – “U” |
| Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. |
Solicitation #140P1426R0012 – Golden Spike Visitor Center Rehabilitation
| Evaluation Area |
| Rating |
| Quality |
| E |
| V |
| S |
| M |
| U |
Quality of workmanship (including subcontractors)?
Quality of and adherence to quality control plan?
Quality of informational and technical submittals?
Overall Quality Rating
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent (E), marginal (M), & unsatisfactory (U) are especially helpful.):
| Schedule (& Time Management) |
| E |
| V |
| S |
| M |
| U |
Met project schedule milestones?
Responded to owner requests in a timely manner?
Informational and technical submittals submitted timely?
Promptly addressed scheduling issues?
Overall Schedule (& Time Management) Rating
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent (E), marginal (M), & unsatisfactory (U) are especially helpful.):
| Cost Control |
| E |
| V |
| S |
| M |
| U |
Addressed differing & unforeseen site conditions so as to minimize additional costs?
Provided fair and reasonable pricing for contract modifications?
Submitted accurate and complete invoices?
Promptly paid subcontractors and suppliers?
Overall Cost Control Rating
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent (E), marginal (M), & unsatisfactory (U) are especially helpful.):
| Management |
| E |
| V |
| S |
| M |
| U |
General oversight by project manager and superintendent?
Coordination with and control of subcontractors?
Avoidance of accidents & safety violations?
Addressed location factors (especially remote locations)?
Maintained good working relationship with owner representatives?
Demonstrated flexibility, innovativeness and cooperation in resolving potential problems?
Overall Management Rating
Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent (E), marginal (M), & unsatisfactory (U) are especially helpful.):
| Small Business Subcontracting (& Labor Standards) |
| Yes |
| No |
Met regulatory and contractual labor standards?
Successfully contracted with small and socio-economically disadvantaged businesses?
Quality and adherence to applicable subcontracting plans?
Overall Small Business Subcontracting (& Labor Standards) Rating
Comments (Please provide comments supporting the above ratings especially if you responded “No”.)
| Regulatory Compliance |
| Yes |
| No |
Met building and life safety codes?
Overall Regulatory Compliance Rating
| Overall Recommendation: |
| Yes |
| No |
Given what I know today about the contractor's ability to perform in accordance with the contract’s most significant requirements, I would recommend them for similar contracts:
Overall Comments:
E. RETURN:
| Return by |
| XXX, 2026 |
| Name |
| Stacy Vallie |
| Title |
| Contracting Officer |
| Organization |
| Northern Rockies Major Acquisition Buying Office / ConOps Central |
| Stacy_Vallie@ios.doi.gov |
File details come from the government source that posted it. Updated .