ID07180031-Appendix_D_Past_Performance-revised_11.13.18.docx

Revised 13 Nov 18

APPENDIX D

PAST PERFORMANCE Evaluation Questionnaire Sheet (NOTE: (NONOTE: This Attachment falls off of the PWS at the time of contract award).

A. GENERAL INFORMATION: One questionnaire should be completed by each past performance reference.

Contractor’s Name: _______________________________ Date of Completion: ___________________ Address: ______________________________________________________________________ Point of Contact and phone number: _______________________________________________________ Contract Number/Project Title: ___________________________________________________________ Contract Type: ________________________________________________________________________ Dollar Value: _________________________________________________________________________ Period of Performance: _________________________________________________________________ Did Contractor performed as the Prime Contractor or Sub-Contractor:____________________________ Brief narrative describing the nature and complexity of the work performed:________________________ B. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 5 that most accurately describes the contractor’s performance or situation. Please provide comments for ratings of Unsat, or Marginal.

Comments:

Comments:

Comments:

Comments:

Comments:

C. Given what I know today about the Contractor's ability to execute what they promised in their proposal, I (pick the following): ______ definitely would not, _____ might or might not, ______definitely would) award to them today given that I had a choice. [END] ** This form must be returned to the GSA Contracting Officer ONLY. Please send this completed for to the CO at the following email address: LATASHA.GOINES@GSA.GOV, by 1 Nov 2018. submitted by the due date/closing date of this solicitation.