Attch_5,_Past_Perf_Questionnaire_(FIO).pdf

FA462019QA201

Attachment 5

FA462019QA201

SEWER CLEANING & VIDEO RECORDING

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

This Past Performance Questionnaire is For Information Only (FIO). This questionnaire is provided as an example of the type of questions that will be asked when the government contacts the references provided by an offeror. No action is required by the offeror for this document.

Explanation of codes:

Code PERFORMANCE LEVEL

RATING DEFINITION

5 Exceptional Based on the offeror’s performance record, the respondent has a high expectation that the offeror will successfully perform the required effort.

4 Satisfactory Based on the offeror’s performance record, the respondent has an expectation that the offeror will successfully perform the required effort.

3 Limited Based on the offeror’s performance record, the respondent has a low expectation that the offeror will successfully perform the required effort.

2 None Based on the offeror’s performance record, the respondent has no expectation that the offeror will be able to successfully perform the required effort.

1 Unknown/Neutral No performance record is identifiable or the offeror’s performance record is so sparse that no confidence assessment rating can be reasonably assigned.

I. CONTRACT INFORMATION: Complete the following information on:

a. Contractor (Company/Name/address):

b. Contract:

1. Number: ___________________________________________________

2. Period of Performance: __________________________________

3. Total Contract Amount: $______________________________________

4. What duties/responsibilities did this job entail?

II. RESPONDENT IDENTIFICATION: Complete the following information on your company. You may be contacted for additional information pertaining to the past/present performance of the contractor identified in section I above. (The following information will assist in the analysis of the data. Information will be kept confidential)

a. Name: ____________________________________________

b. Position and Title: __________________________________

c. Phone Number: _____________________________________

d. Address:

CONTRACTOR PRESENT/PAST PERFORMANCE EVALUATION

1. How effective was the contractor’s recruitment plan for filling the required positions and providing replacements for personnel that discontinued employment under this contract?

5. 4. ____3. ____2. ____1.

COMMENTS/REMARKS:

2. How well did contract personnel perform assigned duties?

3. Were the contract employees knowledgeable and experienced in their position?

4. How well did the contractor correct deficiencies and valid customer complaints in a timely manner and pursuant to their quality control procedures?

5. Was the contractor responsive to contract changes?

6. How effective was the contractor in maintaining professional business relationships with government personnel and in resolving contract issues?

7. How well did the contractor demonstrate the ability to employ, maintain, and replace, if necessary, qualified personnel during the contract period? Please explain.

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

9. Did contract personnel possess all required training and certificates prior to starting? Yes/No ____

10. Were Contract Discrepancy Reports (CDR) issued, Yes/No ____ Were they addressed appropriately? Yes/No ______ If so, how?

11. Was the contractor ever issued a cure or show cause notice under the referenced contract? Yes/No ___

12. Would you award another contract to this contractor? Yes/No ____ Please explain in "remarks”.

REMARKS: