Past Performance Questionnaire 2.pdf

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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

Contractor's Name: _ Address:

Telephone Number: ~ Fax Number: ------------Point of Contact:

(The government enters the following information based on list of references provided by the offerpr.

The offeror will enter this information if the solicitation requires him 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 0 Prime Contractor 0 Sub-Contractor 0 Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent:

Address: _

Title:

Telephone Number: _ Fax Number:

Email Address:

C. FAX COMPLETED SURVEY FORM TO:

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (1, 2, 3, 4, and 5) that most accurately describes the contractor's performance or situation. PLEASE PROVIDE A

NARRATIVE EXPLANATION FOR ANY RATINGS OF 4075.

Based on the offeror's performance record, the government has a high expectation that the offeror will successfully perform the required effort.

Based on the offeror's performance record, the government has an expectation that the offeror will successfully perform the required effort.

Based on the offeror's performance record, the government has a low expectation that the offeror will successfully perform the required effort

Based on the offeror's performance record, the government has no expectation that the offeror will successfully perform the required effort

No performance record is identifiable or the offeror's performance record is so sparse that no confidence assessment rating can be reasonably assigned.

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

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

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

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

4. IHome office participated in solving significant local problems.

5. Followed approved quality control plan.

6. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

6. Identified problems as they occurred.

8. Displayed initiative to solve problems.

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

10 Would you award another contract to this contractor? If not, explain in "remarks

YES/NO

II

CONTRACTOR'S NAME: CONTRACTNUMBER _

Remarks: -------------------------------------