Attachment_6_Past_Performance_Questionnaire.pdf

PERFORMANCE QUESTIONNAIRE

R17PS00812 : NGWSP Block 9 through 11

Your assistance is requested in support of a source selection. The minimum requirement is three (3) sources. Please be aware that the procurement office must receive them by the response date below.

Please complete this Questionnaire mail or email to:

USDOI Bureau of Reclamation Response Date: July 21,2017 Attn: Monica Burgio (UC-863) 125 South State Street, Room 8100 Email: mburgio@usbr.gov Phone: (801) 524-3780

TO BE COMPLETED BY OFFEROR

1. CONTRACTOR NAME & ADDRESS 2. CONTRACT NO.:

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

1a: NAME OF PRIME CONTRACTOR: 5. CONTRACT VALUE (with options): $

6. TYPE OF CONTRACT (fixed price, CMP, FPI, etc.):

7. DESCRIPTION OF CONTRACT REQUIREMENTS:

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION:

a. Evaluator name, position (Project Manager/COR/Other) and organization:

b. Evaluator's Phone Number:

c. Months Performance Monitored by Evaluator:

Please circle response code for each topic (A-G) that best reflects your experience with this contractor.

N = Neutral O= Outstanding B = Better S = Satisfactory M = Marginal

A. Quality of Products and Services - Assess the contractor's conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards.

N O B S M

B. Performance - Assess the contractor's performance as the General Contractor or Architect/Engineer (as appropriate) for the project.

N O B S M

C. Technical Requirements - Assess the contractor's ability to fulfill the technical requirements of the contract.

N O B S M

D. Schedule - Assess the timeliness of the contractor against the schedule of activities.

N O B S M

E. Cost Control - Assess the contractor's ability to manage the contract budget and control costs.

N O B S M

F. Customer Satisfaction - Assess the contractor's responsiveness to customer concerns and "user friendliness".

N O B S M

G. Overall Assessment

N O B S M

Additional Comments:

Solicitation No. R17PS00812

NGWSP Block 9 through 11