Past Performance Questionnaire.pdf

12639522R0041 Attachment 7

N/A=NOT APPLICABLE U=UNSATISFACTORY M=MARGINAL S=SATISFACTORY VG=VERY GOOD E=EXCEPTIONAL

Page 1 of 2 Pages

PAST PERFORMANCE QUESTIONNAIRE

For use in Solicitation # 12639522R0041, (This questionnaire, when completed, shall not be disclosed to anyone outside the Government)

Contractor: Contract#: ________________________________________

Prime or Sub? ________ Contract Value at Award: $ ____________ Final Contract Value: $ ______________________

Contract Type: _______________________ Description of Service: _

Period of Performance: _________________________________ Date Questionnaire Completed: ________________

PLEASE FILL IN THE FOLLOWING RESPONDENT INFORMATION:

Name of Evaluator: ___________________________________ Organization: __________________________________

Phone #: ____________________ Fax #: ____________________ Email: ____________________________________

Position Title: _____________________________ Dates of Involvement in Contract: _____________________________ When responding, circle/highlight the corresponding letter (using the key at the bottom of the page) which most accurately describes the contractor’s performance or situation.

MANAGEMENT:

1. Management performance……………………………………………………….…. N/A U M S VG E

2. Effective Communication……………………………………………………………N/A U M S VG E

3. Working relationship ………………………….……..……… N/A U M S VG E

4. Responsiveness to requirements……….……………………………… N/A U M S VG E

5. Ability to assimilate and incorporate changes in requirements and/or priority.…… N/A U M S VG E

6. Complied with gov’t or other regulations and industry standards…………….…… N/A U M S VG E

7. Willingness to resolve problems in:

(a) Scheduling Projects…………………………………………………….…….. N/A U M S VG E

(b) Quality Control……………………………………………………….…….… N/A U M S VG E

8. Ability to resolve problems in:

(a) Scheduling Projects………………………………………………….……..… N/A U M S VG E

(b) Quality Control………………………………………………………….….… N/A U M S VG E

9. To your knowledge, has contractor had any contracts terminated for default?

(If YES, please explain in “REMARKS”) ...…………………………………....… …….. ….. YES NO

10. Has your organization ever elected to not exercise an option due to contractor’s poor performance? (If YES, please explain in “REMARKS”) …………….. …..YES NO NA

QUALITY

11. Were modifications issued due to contractor failure to meet technical requirements and/or delivery/cost schedules? (If YES, explain in “REMARKS”) …….. ….... YES NO

12. Has a cure notice ever been issued? ...(If YES, explain in “REMARKS”)……… …….. ….... YES NO

13. Has a show-cause letter ever been issued? (If YES, explain in “REMARKS”)… …….. ….... YES NO

12639522R0041 Attachment 7

Page 2 of 2 Pages

COST

14. Ability to meet the terms of the contract within the contractually-agreed price(s).. N/A U M S VG E

15. Have contract concessions/changes ever been made due to contractor’s failure to accurately estimate costs? (If YES, explain in “REMARKS”)………………..…. …….. ….. YES NO

16. Were the proposed costs for new items and/or requests for equitable adjustments considered reasonable?............................................................................................. …….. ….. YES NO NA

17. Have there been any disputes/claims relative to the contract? (If YES, explain in

“REMARKS”)………………………………………………………………..…… …….. ….. YES NO

18. Was the Contractor able to provide current, accurate and complete billing?........... …….. ….. YES NO

GENERAL

19. Contractor’s Overall Cooperation...………………………………………………. N/A U M S VG E

20. Contractor’s Overall Performance…………………………….…………………... N/A U M S VG E

21. Did the Contractor meet contract performance time and/or delivery schedule?...... …….. ….. YES NO

22. Would you award similar contracts to this contractor? (If NO, explain in

“REMARKS”)………………………………………………………………….…. …….. ….. YES NO

23. What do you think was the Contractor’s strongest management attribute and why?

24. What was the Contractor’s weakest management attribute and why? Did the Contractor correct, or attempt to correct the weaknesses?

25. Remarks (areas having significance when considering this contractor for a similar contract; exceptional and unsatisfactory ratings):

THANK YOU IN ADVANCE FOR YOUR ASSISTANCE

Please email to james.g.roloff@usda.gov (specifying 12639522R0041 in subject line) when completed.

N/A=NOT APPLICABLE U=UNSATISFACTORY M=MARGINAL S=SATISFACTORY VG=VERY GOOD E=EXCEPTIONAL mailto:Mary_Stefanos@nps.gov