J.9_-_Past_Performance_Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

(COMPLETE SECTIONS I AND II AND

SEE SOLICITATION SECTION L FOR

SUBMISSION INSTRUCTIONS)

I. CONTRACT IDENTIFICATION

CONTRACTOR NAME: CONTRACT NO:

CONTRACTOR ADDRESS: CONTRACT TYPE:

FIRM-FIXED-PRICE

COST REIMBURSEMENT

OTHER: (specify)

ACTIVE COMPLETED

ROUTINE COMPLEX

DATES OF PERFORMANCE: AWARD AMOUNT: $

TOTAL WITH MODS $

PROJECT DESCRIPTION:

II. AGENCY (CUSTOMER) IDENTIFICATION

AGENCY (CUSTOMER) NAME:

POCNAME/TITLE/PHONE:

III. PAST PERFORMANCE RATING

Rating Scale: E = Excellent. Considerably surpassed requirements/expectations.

G = Good. Surpassed requirements/expectations.

S = Satisfactory. Met requirements/expectations M = Marginal. Met some requirements/expectations U = Unsatisfactory. Did not meet requirements/expectations

1. QUALITY: (Circle applicable rating)

a. Conformance with contract requirements

b. Quality of workmanship (including subcontractors)

E G S M U E G S M U

c. General oversight by project manager and superintendent E G S M U

d. Coordination with and control of subcontractors E G S M U

e. Compliance with Davis-Bacon wage rate and labor usage E G S M U requirements

f. Avoidance of accidents/safety violations E G S M U

2. TIMELINESS:

a. Adherence to project delivery schedules E G S M U

b. Submission of change proposals E G S M U

c. Response to technical direction and change orders E G S M U

d. Response to correction of identified problems E G S M U

e. Submission of timely/accurate/complete billings E G S M U

f. Submission of materials/other submittals E G S M U

3. BUSINESS RELATIONS:

a. Flexibility and cooperativeness in resolving problems E G S M U

b. Tenacity and innovativeness in resolving problems E G S M U

c. Relationships with subcontractors, including prompt payment E G S M U

d. End user was satisfied with services performed E G S M U

IV. COMMENTS

Required for ratings of C (Considerably Surpassed Requirements) or D (Did Not Meet Requirements)

Item No. Comment

Technical Evaluation Panel Member: Date: