Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

Requested for purpose of ESPC contractor selection

Attachment to the Notice of Opportunity

CONTRACT INFORMATION (Contractor to complete #1-4)

1. Contractor Information:

Firm Name:

Address:

Point of Contact:

Contact Phone Number:

Contact email Address:

2. Work Performed as:

___ Prime Contractor ___Subcontractor ___Joint Venture ___Other (Explain)

Percent of project work performed:

If subcontractor, who was the prime? (Firm name/phone #):

3. Contract Information:

Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: ___ ESPC ___Other (Please Specify including Fixed Price/Cost Reimbursable/Other):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Original Construction Acceptance Date (mm/dd/yy) as set forth in the Contract:

Actual Construction Acceptance Date (mm/dd/yy):

Explain difference between original construction acceptance date and actual acceptance date:

Original Implementation Price (excludes finance and service period costs):

Original Contract Price (all costs including design/implementation, finance, and service period costs):

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

Explain difference between original and final contract price:

4. Project Description:

What energy or water conservation measures were employed in the contract (e.g., lighting, controls):

Complexity of Work: ___High ___Med ___Routine

How is this project similar to the project described in the Notice of Opportunity? (Please provide details such as similar equipment, requirements, conditions, etc.)

PV ESA ECM: ESCO Past Performance

ESCO to provide the following information for each of the 3 required projects.

Customer Name:

Customer Type (private company, federal government, other):

Address:

Project Point of Contact:

POC Phone:

POC Email Address:

Contract Type and Description of Work Performed:

Contract Number:

PV Ownership (ESCO, third-party or customer owned):

PV Type and Size:

Contract Amount:

Contract Term:

Contract Status (in progress or paid off):

Project Dates (contract award date, commercial operation date, other):

Evidence of successful performance (accurate reporting, timely delivery, on-cost delivery, and technical excellence):

CLIENT INFORMATION (Client to complete #5-7 and Past Performance Questionnaire below)

5. Client Information:

Name:

Title:

Phone Number:

Email:

6. Describe the client’s role (program manager/contracting/other) in the project:

7. Client’s Signature & Date:

_________________________________ Date: ________________

INSTRUCTIONS TO CLIENT: Please provide responses to the questions below (as applicable) by circling the appropriate adjectival ratings. Please also provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please add below or attach additional pages if necessary).

The Client must complete the questionnaire and submit it directly to the Agency at ____________________. The Agency reserves the right to verify all information on this form.

ADJECTIVAL RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

Rating Definition

(E) Exceptional Performance was substantially and consistently above contract requirements. Contractor displayed an overall superior understanding of contract requirements and may have used innovative approaches leading to enhanced performance.

(VG) Very Good Performance was above minimum contract requirements. Contractor displayed a thorough understanding of contract requirements.

(S) Satisfactory Performance met minimum contract requirements.

(M) Marginal Performance was below minimum contract requirements. Contractor displayed a lack of thorough understanding of contract requirements in one or more significant performance areas.

(U) Unsatisfactory

Performance completely failed to meet the minimum contract requirements. Contractor displayed a total lack of understanding of contract requirements.

(NA) Not Applicable

No information or did not apply to your contract.

PLEASE CIRCLE THE ADJECTIVAL RATING WHICH BEST REFLECTS YOUR

EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY

a) M&V Reports were timely and accurate and showed contracted savings were met. E VG S M U NA

b) Ability to meet quality design and construction standards specified for technical performance E VG S M U NA

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance E VG S M U NA

2. SCHEDULE/ TIMELINESS OF PERFORMANCE

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 NA

3. COMMUNICATION

Contractor’s reasonableness and cooperation in dealing with client staff (including the ability to successfully resolve disagreements/ disputes;

and responsiveness to client requests)

4. MANAGEMENT/ PERSONNEL/ LABOR

a) Effectiveness of management, including management of subcontractors, suppliers, materials, and/or labor force (including the ability to effectively lead, manage and control the program)

E VG S M U NA

b) Continuity in the contractor’s personnel during execution of the contract (e.g., one person or team that stayed with the project throughout the contract)

5. COST/ FINANCIAL MANGEMENT

a) Contractor’s ability to meet the terms and conditions within the contractually agreed price E VG S M U NA

b) Contractor’s ability to propose innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefitted the client

6. SAFETY/ SECURITY

Contractor’s ability to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes following the user’s rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

7. SUBCONTRACT MANAGEMENT

Contractor’s ability to manage subcontracting effort including any subcontracting issues, and the contractor’s ability to resolve the problems without extensive customer guidance.

8. SUMMARY

a) Would you hire or work with this firm again? If no, please explain below. Yes No

b) Provide an overall rating for the work performed by this contractor.