J-3 Past Performance Questionnaire.doc

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

When filled in this document is source selection sensitive information iaw FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: _____________________________________________________________

B. Cage Code: _______________________________________ C. Contract number: ___________________________________________________________________________ D. Contract type (e.g. Fixed price, Cost reimbursement): ______________________________________________ E. Was the referenced contractor the prime contractor on this contract? Yes____ No____

F. Type of Construction Contract: Design-Build_____ Bid-Build _____

G. Was this a competitive contract? Yes _____ No _____

H. Period of performance: _______________________________________________________________________ I. Place of performance: _______________________________________________________________________

J. Initial Contract price: $_______________________________________________________________________ K. Current/final contract price: $__________________________________________________________________ L. Reason(s) for differences between initial contract price and final contract price: __________________________

M. Description of service provided: ________________________________________________________________

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name: _________________________________________________________________________________________ B. Customer or agency description (if applicable): _________________________________________________________________________________________

SECTION 3: REVIEWER IDENTIFICATION

A. Reviewer's name: _________________________________________________________________________________________ B. Reviewer's title: _________________________________________________________________________________________ C. Reviewer's phone/email address: _________________________________________________________________________________________ Number of months the reviewer worked on subject contract: _____________________

SECTION 4: EVALUATION

1. Please describe the quality of the construction work.

2. Please describe the quality of the design work (if applicable).

3. Please describe the quality of the process used to ensure safety

4. Did the contractor complete the project within schedule? If the answer is no, please explain the circumstances for delay.

5. Please describe the contractor’s ability to estimate project costs using R.S. Means.

6. Please describe your willingness to work with this company again in the future.

7. If there were change orders (work that is added to or deleted from the original scope of work of a contract), please describe the contractor’s ability to successfully perform the contract requirements with the change in scope.

Reviewer’s Signature

Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address: ATTN:

JAMES KIM

WHS/A&PO

100 Boundary Channel Drive

Arlington, VA 22202 Or Email a scanned copy to: James.Kim@whs.miil

Or FAX to:

(703) 697-6045