Attachment J5 - Past Performance Questionnaire.doc

PAST PERFORMANCE

EVALUATION SURVEY

A. Contractor’s name and address:

B. Contractor Point of Contact (Name and Title):

C. Phone number (including area code):

D. Contract No.:

E. Project Title:

Description of the Work Performed (Modernization, Full Service Maintenance, Multiple Elevators, etc.): NOTE THAT THE CONTRACT MUST INCLUDE COMPLETED MODERNIZATIONS TO BE CONSIDERED RELEVANT F. Description of Criticality (Hospital, FAA, Government Facility, Military Facility, etc.):

G. Project Award Date: ___________________ Completion Date (Modernization Must Be Completed within the last three years):_________________

H. Project Award Amount: __________________ Final Project Amount: _________________

(Must be at least $150K to be considered Relevant) I. Contractor being evaluated performed as the FORMCHECKBOX Prime Contractor FORMCHECKBOX Subcontractor

J. Respondent Information:

Name:

Organization:

Phone Number:

Email:

K. Authorization is hereby granted to the respondent listed above in section J to provide the information requested in Section B of this survey.

(Signature)

(Name & Title of Authorizing Official) (Date)

SECTION A: CONTRACTOR INFORMATION (to be completed by the contractor requesting evaluation prior to mailing SECTION B: RESPONDENT INFORMATION (to be completed by respondent) *Note: The identity of individual(s) providing reference information shall not be disclosed.

LESS FAVORABLE

MORE FAVORABLE

EVALUATION AREAS

(Circle the appropriate response – if Not Applicable insert N/A next to the statement)

1. Quality

a. Contractor provided effective quality control and inspection procedures which resulted in a quality performance.

b. Contractor completed all modernization work with good workmanship and in conformance with the specifications.

2. Timeliness of Performance

a. Contractor met established project schedules to complete the modernization on time, as scheduled.

b. The contractor met expected elevator maintenance response times.

3. Project Management

a. Contractor acted promptly to resolve problems, ensuring compliance with contract requirements and safety regulations

b. Contractor was reasonable and cooperated to resolve problems, attended meetings as needed and maintained communication.

c. Contractor provided experienced/qualified managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

4. Elevator Performance

a. Elevator performed/operated in accordance with the applicable Statement of Work, Drawings, and Specifications.

5. Compliance

a. Contractor’s performance was in accordance with all applicable Elevator, Safety, Health, and Security requirements and the requirements of the applicable Statement of Work, Drawings, and Specifications.

Overall Past Performance Rating

Call Backs: Please provide the number of unscheduled maintenance call-backs in the first six (6) months of refurbishment and in the first year of refurbishment, to assist the FAA in award evaluation.

· First Six (6) Months: ___________

· First Year: _________

Comments:

EVALUATED BY:

(Signature) (Date)

(Typed or Printed Name)

(Title)