Attachment_06_Past_Performance_Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

DISCS JANITORIAL SERVICES

I. Evaluation of Offeror:

Company/Division Providing Services: ___________________________________________

Address: ___________________________________________________________________

Description of Services Provided: _______________________________________________

Contract Number: _____________________ Dollar Value: ______________

Performance Period: ___________________ Performance Location: ______________

Type of Contract:

Check One:

Fixed Price ______ Price Reimbursement ______ Other (Please Specify) _______

Check One:

Negotiated ______ Sealed Bid ______Competitive ______Non-Competitive _________

Basis of Payment:

Commodity ______ Labor/Equipment Hours ______ Other (specify) ______________

Type & Extent of Subcontracting: ________________________________________________

II. Evaluated by:

Company/Organization/Address: _________________________________________________

Name & Title: ________________________________________________________________

Signature: ______________________________________ Date: _______________________

Telephone: _________________________ FAX: ____________________________

III. Evaluation:

Please answer questions 1 through 8 using the following criteria. Circle only one response per question. For elements rated "unsatisfactory", please comment on the specific problem(s) or performance failure(s) that prompted this rating.

4 - Exceptional: Performance met and exceeded many of the contractual requirements to the organization's benefit. The contractual performance of the element being evaluated was accomplished with few minor problems for which corrective actions were highly effective.

3 - Very Good: Performance met and exceeded some to the contractual requirements to the organization's benefit. The contractual performance of the element being evaluated was accomplished with some minor problems for which corrective actions were effective.

2 - Satisfactory: Performance met contractual requirements. The contractual performance of the element being evaluated was accomplished just as required or accomplished with some minor problems for which corrective actions were satisfactory.

1 – Marginal: Performance barely met contractual requirements. The contractual performance of the element being evaluated reflects a serious problem for which corrective actions have not yet been identified, appear only marginally effective or were not fully implemented.

0 – Unsatisfactory: Performance did not meet some contractual requirement and recovery is not likely in a timely manner. The contractual performance of the element being evaluated reflects serious problems for which corrective actions were ineffective.

N/A: Not Applicable or not observed.

1. Evaluate the contractor's overall commitment to quality performance and customer satisfaction.

4 3 2 1 0 N/A

Comment:

2. Evaluate the contractor's compliance with contractual requirements.

3. Evaluate the effectiveness of the contractor's on-site management and supervision.

4. Evaluate the contractor's ability to provide oversight, measurements, and reporting processes to ensure compliance with all contract requirements and adhere to schedules and complete work on time.

5. On a scale of 1 to 5, 1 being “Not Pleased at all”, 3 being “Satisfied” and 5 being

Extremely Pleased”, how would you rate your organization’s pleasure with the services provided by the contractor?

1 2 3 4 5

6. If given a choice, would you award another contract to the contractor?

Yes No

Assessor’s Signature Date