104_P16PS01045_Past Performance Questionnaire_6.8.16.docx

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Offeror to complete Blocks 1-4)

1. Contractor Information Firm Name: DUNs Number:

Address:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy): Explain Differences:

Original Contract Price (Award Amount):

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

Explain Differences:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NPS PMIS No. NCRO-201541 RFP No. P16PS01045 Construct Law Enforcement Facility at Hains Point, Washington, D.C.

Instructions: Offeror to complete Blocks 1-4. Client to complete Blocks 5-8 and questionnaire. NPS REQUESTS THAT THE CLIENT SUBMIT DIRECTLY BACK VIA EMAIL ATTACHMENT THE ENTIRE COMPLETED QUESTIONNAIRE TO BOTH ALAN_STORMONT@NPS.GOV AND ALBERT_OMARA@NPS.GOV. THE OFFEROR WILL SUBMIT BLOCKS 1-4 OF THE QUESTIONNAIRE TO NPS WITH THEIR TECHNICAL PROPOSAL. THE NPS RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

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

RATING DEFINITION NOTE

There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

NPS PMIS No. NCRO-201541 RFP No. P16PS01045 Construct Law Enforcement Facility at Hains Point, Washington, D.C.

Contractor Information (Firm Name):

Client Information (Name):

TO BE COMPLETED BY CLIENT

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

1. QUALITY:

d) Adequacy of materials, submittals, QC testing, and As-Builts and use of specified materials

E VG S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below)

E VG S M U N

b) Adequacy of initial and revised Progress Schedules and adherence to project delivery schedules

E VG S M U N

3. CUSTOMER SATISFACTION:

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; business-like and communication)?

E VG S M U N

4. EFFECTIVENESS OF MANAGEMENT/ PERSONNEL/LABOR

5. COST CONTROL /FINANCIAL MANAGEMENT

6. COMPLIANCE WITH REGULATIONS AND SAFETY STANDARDS

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk.

(please attach additional pages if necessary):