Attachment_J.22_Past_Performance_Evaluation_Form.pdf

Page 1 of 2 ATTACHMENT J.21

PAST PERFORMANCE EVALUATION FORM

(Check appropriate box)

Performance Elements

Excellent Good Acceptable Poor Unacceptable

Quality of Services/ Work

Timeliness of Performance

Cost Control

Business Relations

Customer Satisfaction

1. NAME & TITLE OF EVALUATOR:_______________________________________________

2. SIGNATURE OF EVALUATOR:_______________________________________________

3. NAME OF ORGANIZATION: ___________________________________

4. TELEPHONE NUMBER OF EVALUATOR:_________________________

5. State type of service received: ___________________________________

6. State Contract Number, Amount and period of Performance _____________________________

7. Remarks on Excellent Performance: Provide data supporting this observation. (Continue on separate sheet if needed)

8. Remarks on unacceptable performance: Provide data supporting this observation. (Continue on separate sheet if needed)

RATING GUIDELINES

Summarize Contractor performance in each of the rating areas. Assign each area a rating of 0 (Unacceptable), 1 (Poor), 2 (Acceptable), 3 (Good), 4(Excellent), or ++ (Plus). Use the following instructions a guidance in making these evaluations.

Quality Timeless Business Product/Service Cost Control of Performance Relations

-Compliance with -Within budget (over/ -Meet Interim milestones -Effective management contract requirements under target costs) -Reliable -Businesslike correspondence -Accuracy of reports -Current, accurate, and -Responsive to technical -Responsive to contract -Appropriateness of complete billings directions requirements personnel -Relationship of negated -Completed on time, -Prompt notification of contract -Technical excellence costs to actual including wrap-up and problems -Cost efficiencies -contract administration -Reasonable/cooperative -Change order issue -No liquidated damages -Flexible assessed -Pro-active

-effective contractor recommended solutions -Effective snail/small disadvantaged business Subcontracting program

0. Zero Nonconformances are comprises Cost issues are comprising Delays are comprising Response to inquiries, technical/ the achievement of contract performance of contract the achievement of contract service/administrative issues is requirements, despite use of requirements. requirements, Despite use not effective and responsive.

Agency resources of Agency resources.

1, Unacceptable Nonconformances require major Cost issues require major Delays require major response to inquiries, technical/ Agency resources to ensure Agency resources to ensure Agency resources to ensure service/administrative issues is achievement of contract achievement of contract achievement of contract marginally effective and requirements. requirements. requirements. responsive.

2.Poor Nonconformances require minor Costs issues require minor Delays require minor Responses to inquiries, technical/ Agency resources to ensure Agency resources to ensure Agency resources to ensure service/administrative issues is achievement of contract achievement of contract achievement of contract somewhat effective and requirements. requirements. requirements. responsive.

3. Acceptable Nonconformances do not impact Cost issues do not impact Delays do not impact Responses to inquires, technical/ achievement of contract achievement of contract achievement of contract service/administrative issues is requirements. requirements. requirements. usually effective and responsive.

4.Good There are no quality problems. There are no cost issues. There are not delays. Responses to inquiries, technical/ service/administrative issues is effective and responsive, 5.Excellent The contractor has demonstrated an exceptional performance level in some or all of the above categories.