B08_Attachment_10_Past_Performance_Questionnaire.pdf

Past Performance Questionnaire

OFFEROR: SUBMIT TO YOUR COMMERCIAL CLIENT OR GOVERNMENT AGENCY REFERENCES FOR PAST PERFORMANCE

PAST PERFORMANCE QUESTIONNAIRE

TO BE COMPLETED BY COMMERCIAL CLIENT'S TECHNICAL MANAGER or BUSINESS MANAGER or AGENCY'S CONTRACTING OFFICER REPRESENTATIVE (COR) or CONTRACTING OFFICER (CO)

Solicitation No.:

Please forward completed Past Performance Questionnaire to (Contracting Officer’s name and email):

Deliver no later than close of business on (enter date):

1. Contractor Name: 2. Contract Number:

3. Contractor Address: 4. Contract Type:

____ Fixed-Price

____ Cost-Reimbursement

____ Other (Please Specify) ____________________

5. Client / Agency Name:

Address:

6. Client / Agency Point of Contact:

Name:

Title:

Phone:

E-mail Address:

7. Period of Performance: 8. Total Contract Value: $

9. Title of Project:

10. Please describe the work that was accomplished focusing on the scope and complexity of the work.:

11. Please describe whether the work was defined by the owner via a specification, statement of work, statement of objectives, partial/complete design document.

12. Did the Contractor encounter any noteworthy problems performing work? ________ If so, Please explain:

NOTE: Please use adjectival ratings from attached sheet

13. Evaluation Factor 14. Comments (Attach additional sheets, if necessary.) 15. Rating

a. Quality of Services Received

b. Personnel

c. Subcontractor Mgmt

d. Business Relations

e. Timeliness of Performance

f. Customer Satisfaction

g. Financial Controls

h. Small Business Subcontractor Goals Attainment

If a subcontracting plan was required under the contract, to what extent did the offeror attain goals for small business participation?

16. Would you select this firm in the future for the same or similar services? Please explain.

17a. Name of Preparer: 17b. Signature:

17c. Title: 17d. Date:

PAST PERFORMANCE RATING GUIDELINES

Summarize contractor performance in each of the rating areas. Assign each area a rating of Unsatisfactory, Marginal, Satisfactory, Very Good, or Excellent. Use the following instructions as guidance in making these evaluations. Note: There is no corresponding guidance for “Customer Satisfaction”. Please use the comments area on the preceding form to justify the rating given “Customer Satisfaction.”

Ratings Quality of Services Received / Personnel -Compliance w/contract requirements -Effectiveness of design -Quality of construction -Accuracy of reports -Appropriateness of personnel assignments -Technical excellence

Financial Controls

-Within budget -Current, accurate, complete billings -Relationship of negotiated prices to actual -Efficiencies -Change orders issued

Timeliness of Performance

-Met interim milestones -Reliable -Responsive to technical direction -Completed on time

Business Relations / Subcontractor Management -Effective on-site management and personnel -Businesslike correspondence -Responsive to contract requirements -Prompt notification of problems -Reasonable / cooperative -Flexible -Proactive -Effective Small Business Subcontracting Program

Excellent There were no quality problems

There were no Financial issues

There were no delays

Business relations and interaction were highly effective

Very Good

Any nonconformance experienced did not impact achievement of contract requirements

Financial issues did not impact achievement of contract requirements

Delays did not impact achievement of contract requirements

Business relations and interaction were usually effective

Satisfactory

Nonconformance required moderate agency involvement to ensure achievement of contract requirements

Financial issues required moderate agency involvement to ensure achievement of contract requirements

Delays required moderate agency involvement to ensure achievement of contract requirements were somewhat effective

Marginal

Nonconformance required major agency involvement to ensure achievement of

Financial issues required major agency involvement to ensure achievement of contract requirements

Delays required major agency involvement to ensure achievement of contract requirements were marginally effective

Unsatisfactory Nonconformance compromised the achievement of contract requirements

Financial issues compromised performance

Delays compromised achievement of contract requirements

Business relations and interaction were not effective and compromised achievement of