Past_Performance_Form.pdf

Source Selection Sensitive Information

Do Not Release

PAST PERFORMANCE QUESTIONNAIRE FOR OWNER OR CONTACTING

OFFICER (CO) /CONTRACTING OFFICER’S REPRESENTATIVE (COR)

Instructions for returning this questionnaire:

Upon completion of the questionnaire, the Owner or CO/COR shall ensure that each page of this questionnaire has been accurately and completely filled out.

The Owner or CO/COR shall ensure that the last page of this questionnaire contains his/her original signature in ink. The survey shall then be placed in an envelope that must be sealed. The Owner or CO/COR shall place his/her signature across the actual envelope seal and include the following statement: "Confidential – Information enclosed is for the sole use of the government."

The sealed envelope shall then be returned to the Contractor. The Contractor will forward the sealed envelope containing the Owner’s evaluation or CO/COR’s evaluation with the rest of their quotation to GSA.

For projects that are not 100% complete, responses should be provided as to contractor’s performance to date.

Contractor being evaluated:

Owner or CO/COR’s contact information (First and Last Name, Title, Company Name, Address, and Telephone Number).

Type of Work the Contractor actually performed for you.

Location of Work the Contractor actually performed for you.

Original Contract Amount:

Actual / Current Contract Amount:

Original Period of Performance (Start and Completion Date):

Actual Period of Performance (Start and Completion Date):

Project Completion Percentage:

Type and Extent of Subcontracting:

Note: An explanation must accompany the answers for all numbered questions.

A. TIMELINESS OF PERFORMANCE AND DELIVERABLES

1. Did the contractor complete the required work and submitted deliverables on schedule?

2. How responsive was the contractor in addressing unforeseen/unanticipated conditions?

3. Did the contractor provide timely monthly progress reports?

_______YES ______ NO

4. Please rate the contractor's timeliness of performance. (Circle one)

Excellent Good Acceptable Unacceptable

B. COST CONTROL

5. Did the contractor submit reasonably price proposals when repairs exceeded the base services of the contract?

6. Please rate the contractor's cost control. (Circle one)

C. QUALITY CONTROL

7. How well has the contractor complied with contract requirements?

8. Did the contractor have the ability to adapt to changing requirements while maintaining a desired level of quality?

9. Please rate the contractor's quality control. (Circle one)

D. BUSINESS RELATIONS

10. How well did the contractor work with the owner and the owner's technical advisors?

11. Was the contractor cooperative, businesslike, and concerned with the interests of projects related to third party entities (i.e. tenants)?

12. Please rate the contractor's business relations. (Circle one)

E. CONTINUITY OF KEY PERSONNEL

13. Did the contractor maintain a consistent project team throughout the duration of the project?

Please provide any additional relevant comments:

14. Please rate the contractor's continuity of key personnel. (Circle one)

15. Would you hire this firm again for similar work? (Check appropriate block)

_______YES ______ NO

16. Please rate the contractor's overall performance. (Circle one)

Evaluated By:

Signature and Date:

Name and Title:

Organization: