Attachment_1-_Past_Performance_Questionaire.doc

CONTRACTOR PAST PERFORMANCE EVALUATION QUESTIONNAIRE

Request you provide the following information on the contractor’s present and/or past performance by placing an X in the space provided by the most appropriate response. If you wish to elaborate on your answer, please provide comments on the lines provided after each question. If more space is needed, continue your comments on a separate sheet of paper and attach it to this questionnaire. You are asked to provide frank, concise comments regarding your overall assessment of the contractor’s performance on the contract identified. You are urged to supplement your own knowledge of the contractor’s performance with the judgment of others in your organization. The following definitions are applicable rating levels of the contractor’s performance on the identified contract. If no performance record is identifiable for a particular question, place an X below “N/A” (Not Applicable).

Performance Confidence Assessment:

Exceptional Confidence Based on the contractor’s performance, no doubt exists that you would hire them again for additional, similar work or that they would complete the work to your satisfaction in a timely manner.

Very Good Confidence Based on the contractor’s performance, minimal doubt exists that you would hire them again for additional, similar work or that they would complete the work to your satisfaction in a timely manner.

Satisfactory Confidence Based on the contractor’s performance, some doubt exists that you would hire them again for additional, similar work or that they would complete the work to your satisfaction in a timely manner.

Marginal Confidence Based on the contractor’s performance, little doubt exists that you would hire them again for additional, similar work or that they would complete the work to your satisfaction in a timely manner.

Unsatisfactory Confidence Based on the contractor’s performance, extreme doubt exists that you would hire them again for additional, similar work or that they would complete the work to your satisfaction in a timely manner.

SECTION A

RESPONDENT IDENTIFICATION

Please provide information for the primary individuals completing this survey.

Name: ________________________________________________________________________

Office Identifier: _______________________________________________________________

Telephone Number: _____________________________________________________________

Mailing Address: _______________________________________________________________

E-Mail Address: ________________________________________________________________ Relation to Contract: ____________________________________________________________

Name: ________________________________________________________________________

Office Identifier: _______________________________________________________________

Telephone Number: _____________________________________________________________

Mailing Address: _______________________________________________________________

E-Mail Address: ________________________________________________________________ Relation to Contract: ____________________________________________________________ Name: ________________________________________________________________________

Office Identifier: _______________________________________________________________

Telephone Number: _____________________________________________________________

Mailing Address: _______________________________________________________________

E-Mail Address: ________________________________________________________________ Relation to Contract: ____________________________________________________________

SECTION B

QUESTIONAIRE

Please complete the following information on the contract[s] you and the subject contractor are involved in:

Contractor / Company Name: _______________________________________ Contractor’s Involvement: ____ Prime Contractor ____ Sub-Contractor

Contract Number / Project Title: ____________________________________________________ Project Description: _____________________________________________________________

Period of Performance: __________________________________

Contract Amount: $__________________ or Range:

__ $10,000 to $100,000

__ $100,000 to $500,000

__ $500,000 to $1,000,000

Contract Type:

__ Firm Fixed Price

__ Cost Reimbursement

__ Other (Specify) _______________________________________________________________ Date Contract Awarded: _______________________

Contract Status: Still Active

__ Yes (If Yes, Contract Completion Date Including Extensions: _______________)

__ No (If No, Date Project Completed: _______________)

MANAGEMENT

Rate the contractor’s ability to provide adequate management, manning, and equipment to complete the work. Also rate the contractor’s ability to respond to contingencies, emergencies, weather, and other environmental delays without falling behind the regular schedule.

Exceptional

Very Good

Satisfactory Marginal Unsatisfactory N/A

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

QUALITY AND QUALITY CONTROL

Rate the contractor’s ability to provide effective quality control and/or inspection procedures to meet accepted standards of good workmanship and ability to take appropriate action to correct deficiencies, in a timely manner, when identified.

Exceptional

Very Good

Satisfactory Marginal Unsatisfactory N/A

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

KNOWLEDGE AND PROFESSIONALISM

Rate the contractor’s knowledge and professionalism as applied to the subject contract.

Exceptional

Very Good

Satisfactory Marginal Unsatisfactory N/A

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PROBLEM RESOLUTION

Rate the contractor’s ability to proactively recognize and resolve unanticipated difficulties. (Did the contractor display initiative to solve problems? Did the contractor identify risks/problems as they occur?)

Exceptional

Very Good

Satisfactory Marginal Unsatisfactory N/A

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ADHERENCE TO SCHEDULES

Rate the contractor’s ability to complete the work within the time frame allocated.

Exceptional

Very Good

Satisfactory Marginal Unsatisfactory N/A

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

WORKING RELATIONSHIP

Rate the working relationship between the contractor and yourself or your organization.

Exceptional

Very Good

Satisfactory Marginal Unsatisfactory N/A

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ENVIRONMENTAL AWARENESS

Rate the contractor’s environmental awareness including compliance and initiatives such as use of recycled products.

Exceptional

Very Good

Satisfactory Marginal Unsatisfactory N/A

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CONTRACT PERFORMANCE

During the course of the subject contract, was the contractor ever placed on notice that their actions were jeopardizing the terms of the contract? (If “Yes”, please explain why.)

Yes

No

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CONTRACT PERFORMANCE

During the course of the subject contract, were payments to the contractor ever withheld due to the contractor’s failure to perform in a satisfactory manner? (If “Yes”, please explain why.)

Yes

No

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SECTION C

SUMMARY

Would you hire this contractor again?

Definitely Yes

Possibly

Definitely Not

No Opinion

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Would you recommend this contractor to others?

Definitely Yes

Possibly

Definitely Not

No Opinion

Comments:________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Provide any additional comments you wish to state about the contractor: