Attachment_3_-_Past_Peformance_Information_Form.pdf

F2K2AC6056A002

ATTACHMENT 3

PAST PERFORMANCE INFORMATION FORM

EXPERIENCE INFORMATION

(To be completed by Offeror)

1. Contractor:

Address:

DUNS Number:

Point of Contact:

Telephone:

Email:

Telephone:

Email:

2. Contract /Task Order(TO) /Purchase Order (PO) Number:

3. Contract/TO/PO Dollar Value:

Contract Completion Dollar Value:

4. Contract/TO/PO Status:

Active Complete

Percent (%) complete and scheduled completion date (if active):

Completion Date (if 100% complete):

5. Project Title: Prime Subcontractor

Location (City and Province):

6. A. Project Description / Scope of Work that the Offeror completed:

B. Provide a short narrative on any adverse issues associated with the completion of this project, if applicable.

FOR OFFICIAL USE ONLY Attachment 3

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: Telephone Number:

Address: Fax Number:

(The offeror will enter this information and is required to submit questionnaires to the references.)

Project Title and Brief Description of Work:

Contract Number Provided by Offeror: Dollar Amount: $ *

Contract Period or Dates of Performance Provided by Offeror: * Contractor performed as the Prime Contractor Sub-Contractor

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: Title:

Address: Telephone Number:

Fax Number:

Email Address:

C. E-MAIL COMPLETED SURVEY FORM TO:

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E VG S M U N

Exceptional Very

Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet some contractual requirements.

The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner.

The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: CONTRACT NUMBER:

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E VG S M U N

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2. Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

3. Delegated authority to project managers and supervisors commensurate with contract requirements.

4. Followed State and local regulations, trends in legislation, and compliance requirements.

5. Followed approved quality control plan.

6. Provided effective quality control and/or inspection procedures to meet contract requirements.

7. Corrected deficiencies in timely manner and pursuant to their

The contractor: E VG S M U N quality control procedures.

8. Provided timely resolution of contract discrepancies.

9. Identified problems as they occurred and suggested solutions.

10. Managed an effective recycling program.

11. Displayed initiative to solve problems.

12. Adhered to schedules and collection requirements.

13. Provided accurate and timely reports.

14. Complied with Federal, State, and local safety regulations.

15. Was responsive to contract changes.

16. Provided adequate project supervision.

17. Effectively managed subcontractors.

18. Paid subcontractors/suppliers in a timely manner.

19. Provided accurate and complete proposals including all aspects of work required for each task.

20. Cooperated with Government personnel after award.

21. How would you rate the contractor's overall performance?

22. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

23. Would you award another contract to this contractor? If not, explain in “remarks.”

24. Is the contractor rated in CPARS?

CONTRACTOR’S NAME: CONTRACT NUMBER:

Remarks: