B12_Past_Perf_Questionnare_L3921R0012.docx

PAST PERFORMANCE QUESTIONNAIRE

MEMORANDUM FOR PROJECT OWNERS/REFERENCES

FROM: Department of Interior Bureau of Land Management Nevada State Office 1340 Financial Blvd Reno, NV 89502

SUBJECT: Request for Past Performance Information

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

Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation (15.506) prohibits the release of the names of individuals providing reference information about an Offeror's past performance. Information will be kept confidential.

It is essential that this office receive your official response no later than 4:00 P.M. PST on Tuesday September 7, 2021. Please email to Kim Ferguson at k1fergus@blm.gov and include “PPQ – 140L3921R0012, RRNCA Pipeline” in the subject line.

We appreciate your assistance in this matter. Please direct any questions you might have to Kim Ferguson at 775-861-6441.

Sincerely, S. Kim Ferguson Contracting Officer

140L3921R0012 RRNCA Potable Water Pipeline Replacements

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 1 for Unsatisfactory, 2 for Marginal, 3 for Satisfactory, 4 for Very Good and 5 for Exceptional. (See page 4 for explanation of rating scale.)

Quality:

-Compliance with contract requirements -Accuracy of reports -Appropriateness of personnel -Technical excellence Comments:

[ ] 1-U

[ ] 2-M

[ ] 3-S

[ ] 4-VG

[ ] 5-E

Cost Controls:

-Within budget (over/under target costs) -Current, complete, and accurate billings -Change orders issued -Issues with payments to suppliers and/or subcontractors Comments:

[ ] 1-U

[ ] 2-M

[ ] 3-S

[ ] 4-VG

[ ] 5-E

Timeliness of Performance / Schedule:

-Met interim milestones -Reliable -Responsive to technical direction -Completed on time, including wrap-up and contract administration -No liquidated damages assessed Comments:

[ ] 1-U

[ ] 2-M

[ ] 3-S

[ ] 4-VG

[ ] 5-E

Business Relations/Customer Satisfaction -Effective management -Business-like correspondence -Responsive to contract requirements -Prompt notification of problems -Reasonable/cooperative -Flexible, pro-active, effective -Recommended viable solutions Comments:

[ ] 1-U

[ ] 2-M

[ ] 3-S

[ ] 4-VG

[ ] 5-E

Overall Assessment

Comments:

[ ] 1-U

[ ] 2-M

[ ] 3-S

[ ] 4-VG

[ ] 5-E

Total Score (Sum of scores from each area)

Mean Score (Sum of scores divided by total number of areas (5)

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.

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

Comments:

10. Was the contractor committed to customer satisfaction? [ ]Yes [ ]No

11. Were you satisfied with the end product? [ ]Yes [ ]No

12. Respondent’s Identification:

Name:

Position/Title:

Address & Phone Number:

Relationship and Time Involved with Program/Contract:

Date of Evaluation:

Signature:

140L3921R0012 - RRNCA Potable Water Pipeline Replacements

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 5 is given) and those that were not met (when a value of 1 or 2 is given) by the contractor. Also calculate the total and mean scores for the ratings.

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 vital information as requested.

RATING GUIDELINES

Use the following instructions as guidance in making evaluations.

QUALITY

-Lack of cooperative spirit -Unsatisfied user; unable to improve relations -Significantly under subcontracting goals -Excessive, unnecessary change proposals to correct poor management -Significantly untimely definitization of change proposals

-Ineffective corrective actions -Did not meet cost/price estimates -Inadequate corrective action plans -No innovative techniques to bring overall expenditures within limits

-Low responsiveness -Low user satisfaction; no attempts to improve relations -Unsuccessful in meeting subcontracting goals -Unnecessary change proposals -Untimely definitizations

-Minor problems with satisfactory corrective actions

-Minor problems which did not affect delivery schedule -Professional and responsive -Met expectations -Adequate user satisfaction -Met subcontracting goals -No untimely change proposals

-Exceeded expectations and user satisfaction -Exceeded subcontracting goals

- Timely response to change proposals

- Use of value engineering or other innovative management techniques which facilitated cost reductions

-Significantly exceeded expectations -High user satisfaction -Significantly exceeded subcontracting goals -Timely response to change proposals image1.jpeg