B08_Attach_4-_Past_Performance_Questionnaire.doc

140L0621R0036 ATTACHMENT 4 - Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

NOTICE TO OFFERORS

Contained herein is the draft letter that the Contracting Officer will use to solicit past performance comments from those organizations or agencies that the offeror has identified in response to the solicitation requirements as well as the complete questionnaire that will be used.

The RFP, in the Proposal Submission Instructions, includes a past performance questionnaire for offerors to send their previous customers with instructions to return the completed questionnaire to the Government. Failure of the references to submit the completed questionnaires shall not be a cause for rejection of the proposal nor shall it be reflected in the Government's evaluation of the offeror's past performance.

Offerors are encouraged to submit the attached cover letter and questionnaire to their references and request the return of the questionnaire to the Contracting Officer as soon as possible prior to the established closing date of the solicitation. Offerors will have to complete the heading and paragraphs 1 through 4 of the questionnaire for each reference.

August 13, 2021 SUBJECT: Request for Performance Information

To Whom It May Concern:

You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. We are currently evaluating this company for award of a contract for a project entitled, “Utah Orphan Well P&A 2021”.

It is requested that you complete the attached questionnaire providing detailed information on the performance history of the firm identified.

It is essential that this office receive your official response as soon as possible and not later than September 13, 2021, 6:00pm- MOUNTAIN TIME. Please submit the completed questionnaire via email to: jrodmansnyder@blm.gov.

Signed, Jennifer Rodman-Snyder

Contracting Officer

1. Contractor Name, Address, Phone Number:

2. Contract Number(s):

3. Contract Value (Base plus Options):

4. Period of Performance:

5. Type of Contract(s) Used: (Check all that apply)

[ ]FP

[ ]FPI

[ ]CR

[ ]T&M

[ ]Labor Hour

[ ]8(a) [ ]Sealed Bid

[ ]Negotiated

[ ]TO/DO

[ ]SB Set-Aside [ ]Competitive

[ ]Non-Competitive

[ ]Requirements [ ]Supplies/Equipment

[ ]Services

[ ]Commercial Items

Acquisition

6. Description of Requirement:

7. Ratings: After commenting, score, in column to the right, using Unsatisfactory, Marginal, Satisfactory, Very Good , Exceptional. (See page 4 for explanation of rating scale.) (Circle)

E

VG

S M U

E

VG

S

VG

S

VG

S

VG

S

VG

S

VG

S

VG

S

VG

S

VG

S

VG

S

VG

S

VG

S

8. Subcontractors, Teaming and Joint Venture Partners. List major subcontractors, teams and joint venture partners, by names, with a brief description of work and names of key personnel.

Subcontractor, Team or Joint Venture

Description of Work

Key Personnel

9. Would you select this firm again? [ ]Yes [ ]No

Comments:

11. Respondent’s Identification:

Name:

Position/Title:

Email Address & Phone Number:

Relationship and Time Involved with Program/Contract:

Date of Evaluation:

Block 1:

Name, address and phone number of the contract being evaluated. Identify the specific division being evaluated if there is more than one.

Block 2:

Contract number(s) used to evaluate performance.

Block 3:

Contract value, including option periods. The value in this block should reflect any increases or decreases affected during the life of the contract.

Block 4:

Dates in which the contractor being evaluated performed work for the evaluator.

Block 5:

Check all blocks that apply to contracts with the contractor being evaluated.

Block 6:

Brief description of the work performed by the contractor.

Block 7:

Indicate the contractor’s rating in the far right column. In the comment areas, provide rationale for the rating. Indicate the contract requirements that were exceeded (when a value of E is given) and those that were not met (when a value of U or M is given) by the contractor.

Block 8:

Identify major subcontractors, team partners and joint ventures and include their work responsibilities. List key personnel employed during the contract that played a major role in the performance rating. Do not list key personnel not employed long enough to effect performance. In some cases, more than one individual may have served in a key position.

Block 9:

Explain why you would or would not select the contractor for this contract again.

Block 10:

State your opinion as to whether or not the contractor is committed to customer satisfaction.

Block 11:

Provide your contact information as requested.

RATING GUIDELINES

Use the following instructions as guidance in making evaluations.

PERFORMANCE RATINGS