Attachment_Past_Performance_Questionnaire_Electrical.docx

Past Performance Questionnaire

Your assistance is requested in support of a source selection.

When complete, the information on this form is SOURCE SELECTION INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

1.A. CONTRACTOR NAME & ADDRESS:

2. CONTRACT/SUBCONTRACT NO.:

3. CONTRACT/SUBCONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT/SUBCONTRACT VALUE (with options):

6. TYPE OF CONTRACT (Fixed Price, FPI, etc.):

7. PROJECT TITLE, LOCATION, AND DESCRIPTION

(INCLUDING TOTAL CONSTRUCTION VALUE):

Description:

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION:

a. EVALUATOR’S NAME, POSITION (Project Manager/COR/Other) AND ORGANIZATION:

b. EVALUATOR’s PHONE NUMBER:

c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

9. Please circle the response code for each topic (A-F) that best reflects your experience with this contractor.

O= Outstanding A= Acceptable U= Unacceptable G= Good M= Marginal N/O=Not Observed

B. Schedule- Assess the timeliness of contractor against the schedule of activities.

O E A M U N/O

C. Performance Requirements- Assess the contractor’s ability to fulfill the performance requirements of the contract.

O E A M U N/O

D. Resource Management- Assess the contractor’s ability to provide and maintain personnel and other resources for the contract.

O E A M U N/O

E. Customer Satisfaction- Assess the contractor’s responsiveness to customer concerns and “user friendliness”.

O E A M U N/O

F. Overall Performance Assessment O E A M U N/O

10. If this was an award fee contract, what was the average award fee earned?

SIGNATURE: