PAST PERFORMANCE QUESTIONNAIRE.pdf

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: _________________________ __________________________ Point of Contact: ______________________

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

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 Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________ _____________________________ Fax Number: ______________________ _____________________________ Email Address: ______________________

C. FAX 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 G S M U N

Exceptional 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

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

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

Performance does not meet some contractual requirements.

The contractual performance of the element or sub-element being assessed reflects a serious problem

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

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

was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

no more than some minor problems for which corrective actions taken by the contractor were effective.

satisfactory.

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.

contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

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

The contractor: E G 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. Home 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

CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER __________

Remarks:_____________________________________________________________________________