Past_Performance_Questionnaire.doc
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Past Performance Form
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PAST PERFORMANCE QUESTIONNAIRE
(COMPLETE SECTIONS I AND II AND SUBMIT WITH THE TECHNICAL PROPOSAL)
I. CONTRACT IDENTIFICATION
| CONTRACTOR NAME: |
| CONTRACT NO: |
CONTRACTOR ADDRESS:
CONTRACT TYPE:
FORMCHECKBOX
FIRM-FIXED-PRICE
FORMCHECKBOX
COST REIMBURSEMENT
FORMCHECKBOX
OTHER: (specify)
FORMCHECKBOX
ACTIVE
FORMCHECKBOX
COMPLETED
FORMCHECKBOX
ROUTINE
FORMCHECKBOX
COMPLEX
DATES OF PERFORMANCE:
AWARD AMOUNT: $
TOTAL WITH MODS
PROJECT DESCRIPTION:
II. AGENCY (CUSTOMER) IDENTIFICATION
AGENCY (CUSTOMER) NAME:
POC NAME/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 |
| E G S M U |
| b. Quality of workmanship (including subcontractors) |
| 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 requirements |
| E G S M U |
| 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 E (Considerably Surpassed Requirements) or U (Did Not Meet Requirements)
| Item No. |
| Comment |
| Technical Evaluation Panel Member: |
| Date: |
Page 1 of 2 STLI 195544 Past Performance Questionnaire
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