Past Performance Form .pdf

BUREAU OF LAND MANAGEMENT

MONTANA/DAKOTA’S REGION

PAST PERFORMANCE QUESTIONNAIRE

I. INTRODUCTION:

A contractor your agency/company has conducted business with has 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, contact the contract officer listed at the address below. Handwritten responses will be accepted as long as writing is legible. If you need more space than provided, please attach additional pages or write on the back. Please include only recent (3 years) and relevant (cultural inventory/reporting) information. DO NOT return this questionnaire to the contractor for submission. It must be sent directly to the Contracting Officer listed below.

IMPORTANT: Past performance questionnaire must be received prior to the closing date and time of the solicitation as listed below.

• Email to: vcummins@blm.gov

III. TYPE OF PROJECT:

• Solicitation #: 140L3620Q0010 – CULTURAL RESOURCE INVENTORY AND SITE UPDATE/

EVALUTION:WEATHERMAN DRAW SITE LOCATION AND RECORDATION PROJECT CARBON

COUNTY

• Closing Date/Time: August 13, 2020 1700 mountain time

• Contract Type: Commercial

• NAICS Code 541690-Other Scientific and Technical Consulting Services

• Project Magnitude: Under $25,000 to $250,000

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 a few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD – Performance meets contractual requirement6s 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 for the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY – Performance does not meet the 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: (Information for Contractor being rated) Contractor: _______________________________________ Contract Number: _______________________________________ Period of Performance _______________________________________ Negotiated price or cost at award: _______________________________________ Current estimated contract dollar amount: _______________________________________ NAICS code: _______________________________________ Describe Service Performed: _______________________________________

VI. EVALUATOR INFORMATION: (Person completing the evaluation)

Name: _______________________________________ Organization: _______________________________________ Phone Number: _______________________________________ Email Address: _______________________________________ Relation to Program: _______________________________________ (i.e. – Contracting Officer, Contracting Officer’s Representative, etc.)

VII: TERMINATION HISTORY:

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

YES _____ NO_____ DEFAULT_____ CAUSE_____ CONVENIENCE_____

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

VII. ASSESSMENT ELEMENTS: Place an “X” in the appropriate space next to the letter for each item on the questionnaire. Narrative statements are vital. For exceptional and very good ratings, please explain per Explanation of Codes above.

1. QUALITY OF SERVICE: 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 completed work 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?)

E_____ V_____ S_____ M_____ U_____ N_____

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)

E_____ V_____ S_____ M_____ U_____ N_____

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) E_____ V_____ S_____ M_____ U_____ N_____

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.).

E_____ V_____ S_____ M_____ U_____ N_____

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_____