Attachment_3_Contractor_Past_Performance_Questionnaire.docx

United States Department of the Interior

FISH AND WILDLIFE SERVICE

1875 Century Boulevard Atlanta, Georgia 30345

(COMPLETED BY CLIENT ONLY!) Attachment 3

In Reply Refer To:

FWS/R4/BA/CGS

April 29, 2015

Re: Contractor Past Performance Questionnaire – Solicitation No.:F15PS00503, Rehabilitate and Repair Dock, Bears Bluff National Fish Hatchery, South Carolina

Prospective Contractor’s Name : Click here to enter text.

Name of Agency/Owner: Click here to enter text.

Referenced Project Name: Click here to enter text.

Referenced Contract/Project No. Click here to enter text.

Dollar Amount of Project: Click here to enter text.

Did the contractor experience any financial problems? Choose an item. If so, what were they? Click here to enter text.

Was the contract performance schedule met? Choose an item. If not, why?

What was the quality of the contractor’s workmanship? Choose an item.

Did contract contain warranty clause? Choose an item. If invoked, what was contractor’s response?

Were there any administrative problems? Choose an item. (payrolls, progress reports, material submittals, etc.) If so, what were they? Click here to enter text.

Were any change orders required? Choose an item. If so who initiated them? Choose an item.

How would you rate this contractor? ☐Outstanding ☐Very Good ☐Satisfactory ☐Unsatisfactory

Would you contract with this company again? Choose an item.

Other Comments: Click here to enter text.

Name of Business/Agency: Click here to enter text.

Point of Contact Name: Click here to enter text. Telephone No.: Click here to enter text.

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