D.3 Past Performance Questionaire.docx

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USFS National Geospatial Services
Solicitation number
12970223R0007
Issued by

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This document is a past performance questionnaire for a contractor to complete and provide as a reference for a solicitation from the US Department of Agriculture Forest Service. The questionnaire requests information on a previous contract including the project title, contract number, awarded price and completion date. It also includes sections for a reference contact to evaluate the contractor's performance on quality, schedule, cost, and management using defined rating criteria. The reference is asked to provide comments supporting the ratings and to recommend the contractor for similar work. The related federal contract opportunity is for national geospatial services from the US Forest Service, with a solicitation number provided.

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PAST PERFORMANCE QUESTIONNAIRE

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.

A. CONTRACTOR INFORMATION

Company Name
Company
Street Address
Address
City
City
State
State
Zip Code
XXXXX
DUNS Number
XXXXXXX
Point of Contact
Name, Email, Phone

B. CONTRACT INFORMATION

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
Street address, City, State
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
N/A
Not Applicable
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 subcontractor)?
Not Applicable
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.

Schedule (& Time Management)

Met project schedule milestones?
Choose an item.
Responded to owner requests in a timely manner?
Choose an item.
Informational and technical deliverables submitted timely?
Choose an item.
Promptly addressed scheduling issues?
Choose an item.
Overall Schedule (& Time Management) Rating
Choose an item.
Comments: Please provide comments supporting the above ratings.

Cost / Price

Provided fair and reasonable pricing for contract awards and modifications?
Choose an item.
Submitted accurate and complete invoices?
Choose an item.
Overall Cost /Price Rating
Choose an item.
Comments: Please provide comments supporting the above ratings.

Management

General oversight by project manager?
Choose an item.
Coordination with and control of subcontractor?
Choose an item.
Maintained good working relationship with all mission partners
Choose an item.
Demonstrated flexibility, innovativeness and cooperation in resolving potential problems?
Choose an item.
Met regulatory and contractual labor standards?
Choose an item.
Overall Management Rating
Choose an item.
Comments: Please provide comments supporting the above ratings.

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
Blaine Greenwalt
Title
Contract Specialist
Organization
United States Forest Service - Special Project Operations Center Southwest
Email
Blaine.greenwalt@usda.gov

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