Attachment A - Past Performance Questionnaire.doc

ATTACHMENT A

PAST PERFORMANCE RISK ASSESSMENT QUESTIONNAIRE

Please return this completed Questionnaire via e-mail to the Contract Specialist. Thank you for your assistance.

Past Performance Questionnaire

Company/Agency Name

Address

Person Completing Survey

Date Survey Completed

Position Held in Reference to the Contract

Length of Involvement in Contract

Email Address

Telephone Number

Fax Number

Contractor

Contract Title

Contract Number

Project Description

Contract Type/Cost

Award Date

Original Contract Price

Final Contract Price

Explain Difference

Percentage of Work Performed by Contractor

Roles and Responsibilities as Sub or Prime

Expected Completion Date

Actual Completion Date

Explain Differences

(Presented for Information Only – Not to be completed by Offeror)

1. Quality of Work:

a) How was the contractor’s compliance with applicable safety standards to protect personnel and company/agency resources?

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

b) How was the contractor’s compliance with applicable labor standards?

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

c) Was the contractor’s effort in Quality Control successful in ensuring quality workmanship on your project?

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

d) Was the contractor committed to customer satisfaction?

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

e) Overall rating for Quality of Work

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

2. Cost Controls:

a) Did the Contractor perform the required services at the contract price without adverse effect on performance?

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

b) Did the contractor submit a fair and reasonable proposal when requested to perform additional work?

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

c) If this contract is an indefinite delivery type contract (e.g., Multiple Award Environmental Contract, Task Order Contract, etc.), has the Contractor submitted competitive quotes on the individual orders issued under this contract?

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Yes

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No

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N/A

d) Overall rating for Cost Controls

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

3. Timeliness of Performance:

a) Was the contractor timely in submitting schedules, reports, billings and other contract submittals?

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Always

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Usually

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Sometimes

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Never

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N/A

b) Was the contractor timely in responding to requests for proposals for additional work?

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Always

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Usually

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Sometimes

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Never

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N/A

c) Did the contractor complete the contract on time taking into account all excusable delays?

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Yes

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No

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N/A

d) Was the contractor assessed any liquidated damages or deductions for late or nonperformance of required work? If yes, please explain.

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Yes

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No

e) Did the contractor exceed contractual requirements in relation to Timeliness of Performance in a way that was deemed beneficial to your agency?

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Yes

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No

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N/A

If you answered No, indicate your reason by checking one of the following:

Contractor met the requirements, but did not exceed them

Did not meet some of the requirements

Did not meet requirements and recovery is not likely

f) Overall rating for Timeliness of Performance

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

4. Effectiveness of Management:

a) Did the contractor award subcontracts in a timely manner and properly manage them?

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Always

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Usually

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Sometimes

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Never

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N/A

b) If applicable, did the contractor meet its small, small disadvantaged and women-owned business participation goals?

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Yes

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No

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N/A

c) How would you rate the management of this firm as it relates to the completion of your contract and to the qualifications of its on-site personnel. Please explain.

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Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

d) Describe the performance of the following personnel (if applicable)

1. Program Manger

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U

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M

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S

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VG

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E

2. Project Manager

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U

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M

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S

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VG

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E

3. Engineering/Technical

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U

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M

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S

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VG

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E

4. Quality Control Manager

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U

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M

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S

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VG

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E

5. Safety Officer

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U

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M

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S

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VG

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E

6. Superintendent

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U

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M

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S

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VG

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E

5. Customer Satisfaction:

a) Did the Contractor show reasonable and cooperative behavior and attention to customer satisfaction?

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Yes

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No

N/A

If you answered NO, please explain why:

6. Overall Rating of Contractor:

In summary, which of the following would you choose to best describe the overall quality of this firm’s past performance?

Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

7. Contact Information

Name of Person Completing Form Position

Project Description

Role of Contractor

Phone No.

The information in this Questionnaire may be verified by Personnel from the U.S. Army Engineering and Support Center, Huntsville.