Past_Performance_Questionnaire.pdf

BUREAU OF LAND MANAGEMENT

MONTANA/DAKOTA’S REGION

PAST PERFORMANCE QUESTIONNAIRE

I. INTRODUCTION:

A contractor your agency/company has conducted business with referenced you for providing information dealing with past performance of a contract of similar nature as a current requirement of the Department of Interior’s Bureau of Land Management.

II. COMPLETION OF QUESTIONNAIRE: For assistance with this form or to request an electronic copy please notify the contract specialist listed at the address below. Handwritten responses will be accepted. If you need more space than provided, please attach additional pages or write on the back.

Please include only recent (3 years) and relevant (same NAICS code) information. Responses will be treated as source selection sensitive information. Return the completed questionnaire by e-mail or mail to the address below. Note: Past performance questionnaire shall be received prior to RFP closing date and time. Failure to meet this deadline may be consider as non-responsive.

Email to: blinford@blm.gov

(U.S. Mail): Bureau of Land Management, Montana State Office, 5001 Southgate Drive, Billings Mt, 59101.

(FedEx/UPS): Bureau of Land Management, Montana State Office, 5001 Southgate

Drive, Billings Mt, 59101.

III. TYPE OF PROJECT:

Solicitation #: L15PS00317

Closing Date/Time: June 22, 2015 at 4:00 pm MT

Contract Type: Construction (Highway)

NAICS Code: 237310

Project description: Bentonite Road Rehabilitation

Project Magnitude: $150K-$500K

IV. EXPLANATION OF CODES:

CODE PERFORMANCE LEVEL

E EXCEPTIONAL – Performance meets contractual requirements and exceeds many

(requirements) to the Government’s benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

mailto:blinford@blm.gov

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE – Unable to provide a score. Performance in this area not applicable to the effort assessed.

PLEASE COMPLETE THE FOLLOWING IDENTIFYING INFORMATION AND PAST

PERFORMANCE ASSESSMENT:

V. CONTRACTOR IDENTIFICATION:

Contractor: _____________________________________________

Contract Number: _____________________________________________

Period of Performance: _____________________________________________

Negotiated price or cost at award: _____________________________________________

Current estimated contract dollar amount: _____________________________________________

NAICS code: _____________________________________________

Describe construction performed: _____________________________________________

VI. EVALUATOR INFORMATION:

Name: _________________________________________________________________

Organization: _________________________________________________________________

Phone Number: _________________________________________________________________

E-Mail Address: _________________________________________________________________

Relation to Program: _________________________________________________________________

(i.e. - Contracting Officer, Contract Specialist/Administrator, Contracting Officer's Representative, etc.)

VII. TERMINATION HISTORY:

1. Has this contract been partially or completely terminated for default/cause/convenience?

YES NO DEFAULT CAUSE CONVENIENCE

If yes, explain (e.g., inability to meet cost, performance, or delivery schedules).

2. Are there any pending terminations? YES NO

If yes, explain and indicate the status.

VIII. ASSESSMENT ELEMENTS: Place an “X” in the appropriate box next to the letter for each item on the questionnaire. Narrative statements are vital. Please provide a supporting narrative for each area.

Attach additional pages if there is insufficient space in the comment area.

1. QUALITY OF CONSTRUCTION (e.g., quality of craftsmanship and materials used.) Does the contractor provide qualified personnel, necessary resources, and quality control? Does the contractor meet established guidelines and policies for safety and security? Did the construction meet the required level of quality?

E V S M U N

2. SCHEDULE (i.e., Does the Contractor provide adequate staffing to meet workload requirements and is the work performed in a timely manner and in accordance with specifications of the requirement?)

3. COST CONTROL (e.g., were obligations performed within the ceiling price in the contract, are contractor requests for additional funds reasonable, are proposals for equitable adjustments reasonable, etc.)

4. BUSINESS RELATIONS (e.g., does contractor promote a strong working relationship with the

Government, does the contractor adequately address and make efforts to resolve issues/problems concerning site employees, does the contractor show initiative, was the contractor courteous and responsive, does the contractor interface effectively with your staff (PI/COR/COTR, etc.)

5. MANAGEMENT OF KEY PERSONNEL (e.g., is the contractor providing the site manager/leader/superintendent or key employees with the necessary resources/knowledge and support to adequately perform their work, does the contractor adequately address and make efforts to resolve issues/problems concerning the site manager/leader/superintendent or key employees, is the contractor able to solve contract performance problems without extensive guidance from government counterparts, etc.)

6. Did the contractor adhere to their technical and management approach? YES NO

If no, explain what was different.

7. Please comment on any other contractor information you consider relevant to this evaluation.

8. Identify the contractor’s overall strengths and weaknesses.

9. Given the choice, would you award to this contractor again? YES NO