NOO Attachment B - Past Performance Questionnaire .docx

Attachment B

PAST PERFORMANCE QUESTIONNAIRE ―

Requested for purpose of ESPC contractor selection 2032H8-22-Q-00035 - IRS HQ, Ogden, Memphis, and Austin

CONTRACT INFORMATION (Contractor to complete #1-4)

1. Contractor Information:

Firm Name:

Address:

Point of Contact:

Contact Phone Number:

Contact email Address:

2. Work Performed as:

___ Prime Contractor ___Subcontractor ___Joint Venture ___Other (Explain) Percent of project work performed:

If subcontractor, who was the prime? (Firm name/phone #):

3. Contract Information:

Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: ___ ESPC ___Other (Please Specify including Fixed Price/Cost Reimbursable/Other):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Original Construction Acceptance Date (mm/dd/yy) as set forth in the Contract:

Actual Construction Acceptance Date (mm/dd/yy):

Explain difference between original construction acceptance date and actual acceptance date:

Original Implementation Price (excludes finance and service period costs):

Original Contract Price (all costs including design/implementation, finance, and service period costs):

Final Contract Price (to include all modifications, if applicable):

Explain difference between original and final contract price:

4. Project Description:

What energy or water conservation measures were employed in the contract (e.g., lighting, controls):

Complexity of Work: ___High ___Med ___Routine How is this project similar to the project described in the Notice of Opportunity? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete #5-7 and Past Performance Questionnaire below)

5. Client Information:

Name:

Title:

Phone Number:

Email:

6. Describe the client’s role (program manager/contracting/other) in the project:__________________________

7. Client’s Signature & Date: _________________________________ Date: ________________

INSTRUCTIONS TO CLIENT: Please provide responses to the questions below (as applicable) by circling the appropriate adjectival ratings. Please also provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please add below or attach additional pages if necessary). The Client must complete the questionnaire and submit it directly to the IRS at william.j.scheierjr@irs.gov. The IRS reserves the right to verify any and all information on this form.

ADJECTIVAL RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

PLEASE CIRCLE THE ADJECTIVAL RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY

2. SCHEDULE/ TIMELINESS OF PERFORMANCE

3. COMMUNICATION

4. MANAGEMENT/ PERSONNEL/ LABOR

5. COST/ FINANCIAL MANGEMENT

6. SAFETY/ SECURITY

7. SUBCONTRACT MANAGEMENT

Contractor’s ability to manage subcontracting effort including any subcontracting issues, and the contractor’s ability to resolve the problems without extensive customer guidance.

E VG S M U NA

8. SUMMARY