Attachment 4 Past Performance Questionnaire.pdf

PR-CI-09-10374

ATTACHMENT 4

PAST PERFORMANCE QUESTIONNAIRE

Name of Company Whose Performance is Being Rated:

The above company is bidding this EPA project as a:

Prime Contractor __________ OR Subcontractor __________

Contract Information

Reference’s Organization: Contract Number:

Contract Title: Contract Value:

Type of Contract: Period of Performance:

The ratings indicated below are to be supplied by the reference identified above and not the offeror.

PERFORMANCE

ELEMENTS

OUTSTANDING

(See Question 5)

EXCELLENT GOOD FAIR POOR

(See Question 6)

1. Quality of Product or Service

2. Timeliness of Performance

3. Business Relations*

4. Overall Performance

* Effective management, including subcontracts; reasonable/cooperative behavior;

responsive to contract requirements; notification of problems; flexibility; proactive versus reactive.

5. Remarks on Outstanding Performance: (Provide information/data supporting this observation. You may continue on a separate sheet, if needed.)

PR-CI-08-11038

6. Remarks on Poor Performance: (Provide information/data supporting this observation. You may continue on a separate sheet, if needed.)

7. Please identify any corporate affiliations with the offeror, if any.

8. Questionnaire completed by:

Name of Evaluator: _________________________

Title:

Date:

Address:

Phone number:

Email:

PRIME CONTRACTOR REFERENCES:

If you are submitting this completed Past Performance Questionnaire for a proposed Prime Contractor, please submit it DIRECTLY to the U.S. EPA Contracting Officer, Scott Tharp, via email (tharp.scott@epa.gov) or fax (513) 487-2107 by 3:00 PM EDT by Friday, May 29, 2009.

If you have any questions, please contact Mr. Tharp at (513) 487-2092.

SUB-CONTRACTOR REFERENCES:

If you are submitting this completed Past Performance Questionnaire for a Sub-Contractor performing greater than $100,000 of work, please submit DIRECTLY to the U.S. EPA Contracting Officer, Scott Tharp, via email (tharp.scott@epa.gov) or fax (513) 487-2107 by 3:00 PM EDT on Monday, June 1, 2009. If you have any questions, please contact Mr. Tharp at (513) 487-2092.