Attachment 5_Past_Performance_Questionnaire1.pdf

DRAFT

Attachment 5

EXHIBIT "B" (Page 1 of 3) Project # ________

PAST PERFORMANCE QUESTIONNAIRE

The contractor listed below is being considered in a source selection by U.S. Customs and Border Protection, Washington, D.C. It would be appreciated if you would provide us with comments regarding the Contractor's past performance. Your comments are considered source selection sensitive;

therefore, you are advised that the Federal Acquisition Regulation (15.506) prohibits the release of the names of individuals providing reference information about an offeror's past performance. In order to maintain the integrity of the source selection process, it is requested that you do not divulge the name of the Contractor nor discuss your comments on this questionnaire with any other individuals. Upon completion of the questionnaire, please place it in a sealed envelope with your company's or agency’s return address and forward to the offeror shown below no later than _______ (Offeror to enter date).

Past Project Information:

1. Offeror (firm submitting this request): _________________________________________

2. Address: _____________________________________ Phone Number:_____________

3. Firm being evaluated (offeror or team subcontractor):_____________________________

4. Contract Number/Project Title being evaluated: _________________________________

Evaluator: (the following information will assist in the analysis of the data. Information will be kept confidential)

1. Name of Evaluator: ________________________________________________

2. Firm/Agency Name Address:

3. Phone Number: __________________

4. Position held or function in relation to project: _____________________________

Rating: Please evaluate the contractor's performance using the following ratings only:

"E" Exceptional The Contractor's performance greatly exceeded the contract requirements.

"HA"

Highly

Acceptable The Contractor's performance exceeded the contract requirements.

"A" Acceptable The Contractor's performance met the contract requirements.

"M" Marginal The Contractor’s performance failed to meet the contract requirements (some material aspects of the Contractor’s performance were less than satisfactory).

"U" Unacceptable The Contractor’s performance failed significantly to meet the contract requirements (performance was poor).

"N/A" Not Applicable The item being rated does not apply or the evaluator has insufficient information to rate the item.

(Do not rate on a "+" or "-" scale. Please use only the ratings provided above, without variation).

Please rate and provide any supporting information for the following:

1. The relationship between the Contractor and owner's contract team and project manager.

____________________________________________________Rating _______

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EXHIBIT "B" (Page 2 of 3) PAST PERFORMANCE QUESTIONNAIRE (continuation sheet)

2. The Contractor's on-site management and coordination of subcontractors.

______________________________________________________________________Rating _______

3. The Contractor's overall corporate management, integrity, reasonableness, and cooperative conduct:

______________________________________________________________________Rating _______

4. The Contractor's performance on delivery of quality work:

______________________________________________________________________Rating _______

5. The Contractor's quality control (CQC):

______________________________________________________________________Rating _______

6. The Contractor's ability to meet the performance schedule:

______________________________________________________________________Rating _______

7. The Contractor's ability/actions to improve schedule problems, if applicable:

______________________________________________________________________Rating _______

8. The Contractor's ability to control costs and provide required work at a reasonable price:

______________________________________________________________________Rating _______

9. The Contractor’s compliance with labor standards, if applicable:

______________________________________________________________________Rating _______

10. The Contractor's compliance with safety standards and/or number of safety related incidents:

______________________________________________________________________Rating _______

EXHIBIT "B" (Page 3 of 3) PAST PERFORMANCE QUESTIONNAIRE (continuation sheet)

11. Has the Contractor been issued any cure notices, show cause letters, letters of reprimand, suspension of payments, termination? If yes, please explain:

_______________________________________________________________Yes ______No _______

12. Would you award another contract to this Contractor? If no, please state reasons for not recommending this Contractor for additional work:

________________________________________________________________Yes ______No ______

13. Was the customer satisfied with the end product?

________________________________________________________________Yes ______No ______

14. Has the Contractor been provided an opportunity to discuss any negative interim or final performance ratings? If so, what were the results?

_________________________________________________________________Yes _____No ______

OVERALL RATING: ______________________

Please provide any additional applicable comments:

EXHIBIT "B" (Page 1 of 3) Project # ________