B08_Attachment_4_Solit_PSP_Vol_I_PastPerf_REQD.pdf

PAST PERFORMANCE QUESTIONNAIRE

SOLICITATION NO. 140P20XXRXXXX

INSTRUCTIONS: Offeror to complete Sections A and B and transmit questionnaire to reference.

Reference to complete Sections C and D and transmit back to Contracting Officer listed in section E.

Notice to Contractor

Information provided in this questionnaire is intended for use as source selection information and as such is deemed Source Selection Sensitive. Statements or comments provided in the questionnaire do not signify an express or implied endorsement of any product, supply, service, or enterprise.

This information shall not be construed as an endorsement by the Government or its employee(s) of the contractor for advertising purposes or in a manner that implies the contractor, its products, or services, are approved, endorsed, or considered by the Government to be superior to other products or services.

The contractor shall not be permitted to use any information provided in this questionnaire to publicize, or otherwise circulate, promotional materials that state or imply Governmental, organizational, group, expert, or individual endorsement or consumer testimonial of a product, service, or position which the contractor represents.

A. OFFEROR INFORMATION

Company Name Company

Street Address Address

City City

State State

Zip Code XXXXX

Unique Entity Identifier

(UEI) Number / SAM

XXXXXXX

Point of Contact Name, Email, Phone

B. CONTRACT INFORMATION FOR PAST PROJECT (PROJECT SUBMITTED UNDER PROJECT

EXPERIENCE)

Project Title Title

Contract Number XXXXXXXXXX

Contract Type Firm Fixed Price / Time & Materials / Cost Reimbursable / Other

Awarded Contract Price $X,XXX,XXX

Current / Final Price $X,XXX,XXX

Contract Award Date XX/XX/XXXX

Contract Completion Date XX/XX/XXXX

Period of Performance XX/XX/XXX – XX/XX/XXX

Project Location Park or Street address, City, State

Client / Owner Company

Brief description of the contract & work effort:

Scope of work description

C. REFERENCE:

Name First, Last

Position / Title Title

Organization Agency or Company

Phone Number XXX-XXX-XXXX

Email Address Email

Signature Signature

Date XX/XX/XXXX

D. EVALUATION

Rating Definition

Exceptional

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

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 Performance met contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal Performance did not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.

Unsatisfactory

Performance does 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 appear or were ineffective.

Evaluation Area Rating

Quality

Quality of workmanship (including subcontractors)? Choose an item.

Quality of and adherence to quality control plan? Choose an item.

Quality of informational and technical submittals? Choose an item.

Overall Quality Rating Choose an item.

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? Choose an item.

Responded to owner requests in a timely manner? Choose an item.

Informational and technical submittals submitted timely? Choose an item.

Promptly addressed scheduling issues? Choose an item.

Overall Schedule (& Time Management) Rating Choose an item.

Cost Control

Addressed differing & unforeseen site conditions so as to minimize additional costs? Choose an item.

Provided fair and reasonable pricing for contract modifications? Choose an item.

Submitted accurate and complete invoices? Choose an item.

Promptly paid subcontractors and suppliers? Choose an item.

Overall Cost Control Rating Choose an item.

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? Choose an item.

Coordination with and control of subcontractors? Choose an item.

Avoidance of accidents & safety violations? Choose an item.

Addressed location factors (especially remote locations)? Choose an item.

Maintained good working relationship with owner representatives? Choose an item.

Demonstrated flexibility, innovativeness and cooperation in resolving potential problems? Choose an item.

Overall Management Rating Choose an item.

Small Business Subcontracting (& Labor Standards)

Met regulatory and contractual labor standards? Choose an item.

Successfully contracted with small and socio-economically disadvantaged businesses? Choose an item.

Quality and adherence to applicable subcontracting plans? Choose an item.

Overall Small Business Subcontracting (& Labor Standards) Rating Choose an item.

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

Regulatory Compliance

Met building and life safety codes? Choose an item.

Overall Regulatory Compliance Rating Choose an item.

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: Choose an item.

Overall Comments:

E. RETURN:

Return by Time / Date

Name CO or CS name

Title Contracting Officer / Contract Specialist

Organization National Park Service – Denver Service Center

Email First_Last@nps.gov

Notice to Contractor

Information provided in this questionnaire is intended for use as source selection information and as such is deemed

Source Selection Sensitive. Statements or comments provided in the questionnaire do not signify an express or implied endorsement of any product, supply, service, or enterprise.

This information shall not be construed as an endorsement by the Government or its employee(s) of the contractor for advertising purposes or in a manner that implies the contractor, its products, or services, are approved, endorsed, or considered by the Government to be superior to other products or services.

The contractor shall not be permitted to use any information provided in this questionnaire to publicize, or otherwise circulate, promotional materials that state or imply Governmental, organizational, group, expert, or individual endorsement or consumer testimonial of a product, service, or position which the contractor represents.