B01 Attachment J05 Past Performance Questionnaire.docx
DOCX document 16 KB Posted
- Attached to
- Belcourt Replace Steam Boiler Design Build
- Solicitation number
- 75H70124R00031
About this file
This document is a Past Performance Questionnaire to be completed by a client for a construction contractor proposing on a contract with the Indian Health Service (IHS). The questionnaire requests the client to provide an adjective rating and comments on the contractor's performance in various categories such as quality, schedule, cost control, management, small business participation, and regulatory compliance. The document includes detailed rating guidance to assist the client in providing an appropriate evaluation.
The related federal contract opportunity is a solicitation from the IHS for the Belcourt Replace Steam Boiler Design Build project, which involves the complete replacement of the facility's existing steam boiler. The project will be procured as a 100% Small Business set-aside under NAICS code 238220, with a size standard of $19 million. The contract type is a Firm Fixed Price (FFP) construction contract with a period of performance of 365 calendar days. The estimated magnitude of the project is between $250,000 and $500,000. The evaluation will be based on the Lowest Price Technically Acceptable (LPTA) method.
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Text version
PAST PERFORMANCE QUESTIONNAIRE
Instructions to client:
The contractor is proposing for a construction contract with Indian Health Service https://www.ihs.gov/ You are requested to complete this form, sign, and return it to the contractor so it may be submitted with their proposal.
PART I CONTRACT INFORMATION (Contractor to complete)
Contractor Name:
Project Title
Award Value
Period of Performance
| Prime Contractor or Subcontractor |
| ☐ Prime ☐ Subcontractor |
Agency or Entity Name and Address
PART II PERFORMANCE INFORMATION (Client to complete)
Name / Title
Phone #
Email Address
Contract Type
Signature
Instructions: Please select the adjective rating that best reflects your evaluation of the contractor’s performance. See Part III for rating guidance.
| Category |
| Exceptional |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| N/A |
Quality
Schedule
Cost Control
Management
Small Business
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Regulatory Compliance | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| Comments (expand as needed) |
PART III RATING GUIDANCE
| RATING |
| DEFINITION |
| NOTE |
| (E) Exceptional |
| Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| To justify an Exceptional rating, identify multiple significant events and state how they were of benefit to the Government. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified. |
| (VG) Very Good |
| Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| To justify a Very Good rating, identify a significant event and state how it was a benefit to the Government. There should have been no significant weaknesses identified. |
| (S) Satisfactory |
| Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory. |
| To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract/order. There should have been NO significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be evaluated with a rating lower than Satisfactory solely for not performing beyond the requirements of the contract/order. |
| (M) Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects 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. |
| To justify Marginal performance, identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the Government. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter). |
| (U) Unsatisfactory |
| Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. |
| To justify an Unsatisfactory rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the Government. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g., management, quality, safety, or environmental deficiency reports, or letters). |
| (N) Not Applicable |
| No information or did not apply to your contract |
| Rating will be neither positive nor negative. |
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