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Attachment 4
PAINTING OF WHARF ALPHA PORTAL CRANE
FA441818Q0025
PAST PERFORMANCE EVALUATION QUESTIONNAIRE
GENERAL INFORMATION:
| Contractor’s Name: | ____________________ | Point of Contact: ____________________ | |
| Address: | ________________________________________________________________ | | |
| Telephone Number: | ____________________ | Fax Number: | ______________________ |
Project Title or Brief Description of work: _________________________________________* Contract Number Provided by Offeror: ____________________Type of Contract: _________* Annual Dollar: ____________________ Total Dollar Amount: ______________________* Contract Period or Dates of Performance Provided by Offeror: __________________________* *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.
Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.
B. RESPONDENT INFORMATION:
Name of Respondent: _____________________ Title: ___________________________
| Address: _____________________ | Telephone Number: | ___________________ | |
| _____________________ | Fax Number: | | ___________________ |
| _____________________ | Email Address: | | ___________________ |
C. Submit Completed Survey with Proposals
| D. | PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2. |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
Unsatisfactory
| Marginal |
| Satisfactory |
| Very Good |
| Exceptional |
| Neutral (N) |
| Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective. |
| Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective. |
| Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory. |
| Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems which the contractor resolved in a timely, effective manner. |
| Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner |
| No record of past performance, the record is inconclusive, or not applicable |
CONTRACTOR’S NAME : ___________________________________
CONTRACT NUMBER: ______________________________________
The contractor:
| 1. |
| Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements. |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 2. |
| Provided timely resolution of contract discrepancies. |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 3. |
| Identified risks/problems as they occurred. |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 4. |
| Suggested alternative approaches to problems. |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 5. |
| Displayed initiative to solve problems. |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 6. |
| Provided adequate project supervision. |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 7. |
| Cooperated with Government personnel during performance. |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 8. |
| Provided an adequate Coating Work Plan and Lead Waste Management Plan |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 9. |
| Performed Coating Maintenance IAW USGS 02-82-33.13 and 09-97-13.26 |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 10. |
| Performed Coating Maintenance for Steel Waterfront Structures |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 11. |
| Performed Lead Abatement Services |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 12. |
| Provided proper paint & lead abatement certifications |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 13. |
| How would you rate the contractor’s overall performance |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| N |
| 14. |
| Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.” |
| 15. |
| Would you award another contract to this contractor? If not, explain in “remarks.” |
| 16. |
| Is the contractor rated in CPARS? |
Remarks:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Attachment 3
