B08_Solicitation_-_Attachment_4_-_Past_Performance_Questionnaire.pdf

For Official Use Only/Source Selection Information

Past Performance Questionnaire Project Name:

Solicitation Number:

Contracting Point of Contact:

Elevator Rehab - Gateway Arch National Park

140P6222R0001

Jason Sewell National Park Service 7400 Grant Road Affton, MO 63123

Email: Jsewell@nps.gov

Instructions:

1) The offeror is to complete only the information in Section A and submit as part of the solicitation package.

2) The contracting point of contact with then contact the project owner (or reference) with a request to complete Section B and provide back to the contracting point of contact, which will then be reviewed for evaluation.

3) The past performance questionnaire must be received by the contracting point of contact by the date and time specified in the solicitation (or any amendments). Late past performance questionnaires will not be accepted.

4) One past performance questionnaire is to be used for each past performance project submitted. The offeror is to submit up to but no more than 3 past performance questionnaires for this solicitation. Past performance projects must have been completed within ten years of the completion of performance of the evaluated contract or order.

Attachment 5 - 11/9/2021

Section A – To be completed by the offeror

The project information in Section A shall reference the past performance project, not the solicitation project. The description of the work performed must be sufficiently detailed for Government to make a determination of relevance in size, scope, and complexity of each project listed to the work described in this solicitation.

Offeror’s Company Name:

DUNS Number:

Project Name:

(Name of the past performance project) Project Completion Date:

Project Value:

Description of the work completed by the offeror:

Describe the relevancy of the past performance project to the work required in the solicitation:

Section B – To be completed by the project owner (or reference)

The information provided by the project owner may be verified by contacting references as deemed necessary by the Government.

Project Owner Company Name or Department:

Project Owner Point of Contact:

Name and Title/ Position

Point of Contact Phone Number:

Point of Contact email Address:

Past Performance Rating Scale

Rating Definition

Excellent Performance considerably exceeded requirements/expectations.

Good Performance exceeded requirements/expectations.

Satisfactory

Performance met the requirements/expectations. If any minor problems occurred, corrective actions taken by the contractor were satisfactory.

Marginal Performance did not meet some contractual requirements and reflects a serious problem in the element being assessed.

Unsatisfactory

Did not meet requirements/expectations. The element being assessed contained a serious problem(s) for which the contractor’s corrective actions were ineffective.

Section B CONTINUED - To be completed by the project owner (or reference)

Past Performance Rating Select applicable rating

Ex ce lle nt

G oo d

Sa tis fa ct or y

M ar gi na l

U ns at is fa ct or y

N ot

A pp lic ab le

Quality of workmanship, including subcontractors work

Conformance with contract requirements

Resolved any issues that occurred

Management of overall project and subcontractors

Adhered to performance period, completed work on time

Responded to owner requests in a timely manner

Conducted business-like cooperation with the project owner and communicated well with all project shareholders – ie: provided documentation timely, ensured minimal errors in documentation, responsive to both owner and contracting office, etc.

Yes No Overall, the Project Owner was satisfied with the services performed for this project Based on the experience with this contractor for this project, I would recommend them for similar contracts Comments (may provide additional pages for comments):

Signature of Project Owner Point of Contact:

Once completed and signed, the project owner (or reference) is to submit the entire completed past performance questionnaire back to the offeror to be provided with their complete proposal package, which will then be reviewed for evaluation.