PAST PERFORMANCE SURVEY FORM.doc

(Attachment #3) – Solicitation # 140F0220Q0025/02

PAST PERFORMANCE SURVEY

SECTION A: Contractor Information (to be completed by the contractor for who past performance information is being collected, prior to forwarding to respondent)

1. Prospective Government Contractor's______________________________________

Name and Address:

2. Contractor Point of Contact: ___________________________________________

3. Phone number (with area code):___________________________________________

4. Contract number for the service that was provided: ___________________________________________

5. Description of Services performed under contract referenced in item 4: _____________________________________________________________________________

6. Contract award date: ___________ Contract award amount: _________________

7. Period of performance: ___________________________________________________

8. Authorization is hereby granted to provide the information requested in this survey to USFWS, Contracting and Grant Services Division, Atlanta, Georgia

(Signature)

(Name and Title of Authorizing Official)

(Date)

SECTION B: Respondent Information (to be completed by respondent)

(Signature)

(Date)

(Typed or Printed Name)

(Organization Name)

(Title)

(Phone Number)

(Organization Address)

Note: The identity of individual(s) providing past performance information shall not be disclosed.

Respondent should complete survey and submit NLT than the due date and time specified within this solicitation to:

E-mail: joni_dutcher@fws.gov The following Rating Scale provides the definitions for the Past Performance ratings to be assessed:

E

EXCEPTIONAL

Based on the Offeror's performance record, essentially no doubt exists that the Offeror will successfully perform the required effort. Past performance has met contractual requirements and has exceeded some to the respondent's benefit. Contractual performance was accomplished with few minor problems for which corrective action(s) taken by the contractor were highly effective.

V

VERY GOOD

Based on the Offeror's performance record, little doubt exists that the Offeror will successfully perform the required effort. Past performance has met contractual requirements and has exceeded some to the respondent's benefit. Contractual performance was accomplished with some minor problem(s) for which corrective action(s) taken by the contractor were effective.

S

SATISFACTORY

Based on the Offeror's performance record, some doubt exists that the Offeror will successfully perform the required effort. Past performance has met contractual requirements. Contractual performance contains some minor problem(s) for which corrective action(s) taken by the contractor appear or where satisfactory.

M

MARGINAL

Based on Offeror's performance record, substantial doubt exists that the Offeror will successfully perform the required effort. Past performance has not met some contractual requirements. Contractual performance reflects a serious problem for which either the contractor has not yet identified correction action(s), or the proposed corrective action(s) appear only marginally effective or were not fully implemented.

U

UNSATISFACTORY

Based on Offeror's performance record, extreme doubt exists that the Offeror will successfully perform the required effort. Past performance has not met most contractual requirements, and recovery did not occur or was not in a timely manner. Contractual performance contains serious problem(s) for which the contractor's corrective action(s) appear or were ineffective.

N

NEUTRAL

No performance record identifiable; unknown performance.

SECTION C: The questions on the survey shall be rated in accordance with the definitions provided in the Rating Scale. Any unsatisfactory or marginal rating shall be supplemented with an explanation in the space provided.

QUALITY OF SERVICE

1. Rate the contractor's compliance with contractual

E V S M U N requirements.

2. The contractor exhibited the ability to identify and correct non-compliance issues.

3. The contractor exhibited the ability to improve business processes resulting in increased quality.

4. Overall rating of contractor quality of service.

COMMENTS:

SCHEDULE

1. Delivery of service was within required time period specified by contract requirements.

2. Rate the contractor's ability to respond in a timely manner to expanded requirements.

3. Rate the contractor's ability to adjust manning and equipment to respond to expanded requirements without falling behind regular schedule.

4. Overall rating of contractor conformance to schedule.

BUSINESS RELATIONS

1. Rate the working relationship between contractor's management, your company and your designated representatives (to include inspection personnel).

2. Rate the contractor's ability to submit reports and/or invoices. Are they complete and accurate?

3. Rate the contractor's ability to submit required reports and/or invoices in a timely manner.

4. Rate the contractors responsiveness to customer complaint resolution.

5. Overall rating of contractor's business relations.

MANAGEMENT OF KEY PERSONNEL

1. Rate the contractor's ability to select, retain, support, and replace key personnel (Project Manager, Alternate, Supervisors).

2. Rate the working relationship between contractor's key personnel, your company and your designated representatives (to include inspection personnel).

SECTION D: How would you feel about awarding another contract to this contractor?

Wouldn't hesitate to award another contract to this contractor.

Would most likely award another contract to this contractor.

Would think twice about awarding another contract to this contractor, but would do so if no better alternative existed.

Do not wish to award another contract to this contractor.

Would not award another contract to this contractor.

ADDITIONAL REMARKS:

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