Atch_5-Past_Present_Performance_Questionnaire.docx

FOR OFFICIAL USE ONLY

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 & 3.104 Past/Present Performance Questionnaire

FA441718R0010

ATTACHMENT 5

SECTION A: CONTRACTOR INFORMATION

1. Contractor’s Name and Address:

2. Point of Contact:

3. Phone Number:

4. Contract Number:

Contract Type:

5. Period of Performance:

SECTION B: RESPONDENT INFORMATION (To Be Completed By Evaluation Respondent)

1. Respondent’s Company Name & Address:

2. Respondent’s Name:

3. Phone Number:

Fax Number:

E-Mail:

4. Award Amount:

Final Amount:

5. Project Title:

Project Number:

6. Brief Project Description:

7. Period of Performance:

Start Date:

End Date:

SECTION C: EMAIL OR FAX COMPLETED QUESTIONNAIRE FORM TO:

OR

THIS FORM MUST BE RETURNED NO LATER THAN: The closing date and time of solicitation.

SECTION D: PERFORMANCE INFORMATION: Choose letter on the scale that most accurately describes the contractor’s performance or situation. PLEASE PROVIDEA NARRATIVE EXPLANATION FOR ANY UNSATISFACTORY OR MARGINAL RATINGS.

Exceptional (Outstanding) Very Good (Above Average)

Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the Contractor were highly effective

Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the Contractor were effective

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

No record of past performance or the record is inconclusive.

1. QUALITY: Access conformance to contract requirements, specifications and standards of Good Workmanship. Provided effective quality control which resulted in a quality finished product.

☐ Exceptional ☐Very Good ☐Satisfactory ☐Marginal ☐Unsatisfactory ☐Not Available

COMMENTS/REMARKS:

2. SCHEDULE: Developed realistic progress schedules and completed the project within the established schedule.

COMMENTS/REMARKS:

3. MANAGEMENT: Provided experienced superintendent, managers, and supervisors, with the technical and administrative abilities to meet requirements. Adequately coordinate and controlled performance of subcontractors. Identified problems as they occurred. Suggested approaches to resolving problems. Displayed initiative and cooperation in solving problems. Provided adequate information and pricing for change orders and negotiated them in good faith. Provided timely resolution of punch list items and closeout documentation. Provided submittals in a timely manner. Submittals were well researched and clearly identified the proposed item.

COMMENTS/REMARKS:

4. UTILIZATION OF SMALL BUSINESS: Contractor complied with terms and conditions for Small Business Participation. Achieved Small Business Goals.

COMMENTS/REMARKS:

5. REGULATORY COMPLIANCE: Contractor complied with Financial, Environmental, Safety, and Reporting Requirements. Contractor was compliant with labor standards, posting of EEO, labor rates, minimum wage.

Payrolls were completed properly and received in a timely matter. Paid subcontractors in a timely manner Contractor had an adequate safety plan and it was implemented properly. No safety discrepancies were noted.

COMMENTS/REMARKS:

6. LIQUIDATED DAMAGES: Was the contractor assessed liquidated damages? ☐YES ☐NO (If Yes, briefly explain the circumstances)

COMMENTS/REMARKS:

7. Based on the contractor’s overall performance, would you rehire this contractor? ☐YES ☐NO

OVERALL PERFORMANCE RATING:

Signature of Respondent: ________________________________________________________ Date: ________________ FOR OFFICIAL USE ONLY SOURCE SELECTION SENSITIVE – SEE FAR 3.104 Page 1