Form B Past_Performance_Questionnaire.doc

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STABILIZE WEROWOCOMOCO DAM
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140P4220R0033
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FORM B:PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS: Offeror to complete Sections I and II and transmit questionnaire to reference listed in Section II

Reference to complete Sections III and IV and transmit back to Contracting Officer (see contact information at bottom of form)

I. CONTRACT IDENTIFICATION

CONTRACTOR NAME:
CONTRACT NO:

CONTRACTOR ADDRESS:

CONTRACT TYPE:

[ ] FIRM-FIXED-PRICE

[ ] COST REIMBURSEMENT

[ ] OTHER____________________________

[ ] ACTIVE

[ ] COMPLETED

[ ] ROUTINE

[ ] COMPLEX

DATES OF PERFORMANCE:
AWARD AMOUNT

TOTAL WITH MODS

PROJECT DESCRIPTION:

II. AGENCY (CUSTOMER) IDENTIFICATION

AGENCY/CLIENT (CUSTOMER) NAME:

TITLE/PHONE:

III. PAST PERFORMANCE RATING

Rating Scale:

E = Excellent. Considerably surpassed requirements/expectations.

G = Good. Surpassed requirements/expectations.

S = Satisfactory. Met requirements/expectations

M = Marginal. Met some requirements/expectations

U = Unsatisfactory. Did not meet requirements/expectations

1. QUALITY:

(Circle applicable rating)

a. Conformance with contract requirements
E

G S M U

b. Quality of workmanship (including subcontractors)
E

G S M U

c. General oversight by project manager and superintendent
E

G S M U

d. Coordination with and control of subcontractors
E

G S M U

e. Compliance with Davis-Bacon wage rate and labor usage requirements
E

G S M U

f. Avoidance of accidents/safety violations
E

G S M U

g. Ability to work in remote locations, if applicable
E

G S M U

2. TIMELINESS:

a. Adherence to project delivery schedules
E

G S M U

b. Submission of change proposals
E

G S M U

c. Response to technical direction and change orders
E

G S M U

d. Response to correction of identified problems
E

G S M U

e. Submission of timely/accurate/complete billings
E

G S M U

f. Ability to meet project schedule milestones
E

G S M U

g. Submission of materials/other submittals
E

G S M U

3. BUSINESS RELATIONS:

a. Flexibility and cooperativeness in resolving problems
E

G S M U

b. Tenacity and innovativeness in resolving problems
E

G S M U

c. Relationships with subcontractors, including prompt payment
E

G S M U

d. Relationships with owner’s representative
E

G S M U

e. End user was satisfied with services performed
E

G S M U

IV. COMMENTS

Provide any additional comments for items in Section III

Item No.
Comment

POC SIGNATURE/DATE:

Please provide contact information where you may be reached during normal business hours:

National Park Service Contact Information:

Contracting Officer:

Contract Specialist: L.J. Gravelle LJ_Gravelle@nps.gov

PAGE

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