B08_ATT_12_Past_Perf_Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

The U.S. Department of Interior Bureau of Land Management (BLM) has a requirement for an Alaska Legacy and Orphaned Well Remediation - Indefinite Delivery Indefinite Quantity (IDIQ) contract. As part of the procurement process, past performance is a source selection factor.

The offeror shall complete the included Past Performance Questionnaire for up to three (3) complete projects performed by the prime contractor within the last (7) seven years that are proposed to be similar scope, magnitude of effort, and complexities. The offeror shall fill out Part A & B and coordinate completion of Parts C & D with the respective reference. Completed Past Performance Questionnaires shall be included in the offeror’s proposal and not sent directly to the agency.

The offeror is responsible for compiling and submitting completed past performance questionnaires in its proposal, though the Government may contact references to verify the veracity of provided information.

References shall not send completed past performance questionnaires to the Government.

A. CONTRACTOR INFORMATION

Company Name Street Address City State Zip Code UEI Number Point of Contact

B. CONTRACT INFORMATION

Project Title Contract Number Contract Type Awarded Contract Price Current / Final Price Contract Award Date Contract Completion Date Project Location Client / Owner Brief description of the contract & work effort:

C. REFERENCE:

Name Position / Title Organizati on Phone Number Email Address Signature

Date

D. EVALUATION

Rating Definition

Exceptional (EX) 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 (VG) 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 contained some minor problems for which corrective actions taken by the contractor 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 action.

Unsatisfactory (U)

Performance did 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 were ineffective.

Not Applicable

(NA)

The element does not pertain to the subject project as a result of specific contract and/or project requirements.

Evaluation Area Rating Quality

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, marginal, & unsatisfactory are especially helpful.):

Schedule & Time Management Met project schedule milestones and/or deadlines?

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, marginal, & unsatisfactory are especially helpful.):

Pricing and Payments Minimized additional costs when addressing differing & unforeseen site conditions?

Provided fair and reasonable pricing for contract modifications?

Submitted accurate and complete invoices?

Promptly paid subcontractors and suppliers?

Overall Pricing and Payment Rating Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Management 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, marginal, & unsatisfactory are especially helpful.):

Regulatory Compliance Met local and/or Federal requirements for plugging & abandonment?

Met regulatory and contractual labor standards?

Overall Regulatory Compliance Rating Overall Recommendation:

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: