-Reference Check Past Performance Questionnaire (1).pdf

Page | 1 Rev.12-18-2018

REQUEST FOR PROPOSAL (RFP) # BPM004287

ADEQ Project: “Asbestos, Lead and Mold Abatement Services”

Past Performance Questionnaire Contractor: SPRAY SYSTEMS OF ARIZONA INC

Please email the completed Past Performance Questionnaire to Forbin.Merrilyn@azdeq.gov

Reference Check provided by

Name ___________________________________________________________________________

Title_____________________________________________________________________________

Agency/Company_________________________________________________________________

Email Address____________________________________________________________________

Phone Number ___________________________________________________________________

Rating: 0 being the lowest and 6 being the highest

1. Has the Contractor listed above provided Asbestos, Lead and Mold Abatement services for your agency/company? Yes☐ No☐

i) If yes, how would you rate the quality of work performed by this Contractor on your project?

Please provide a rating from 0 to 6:

ii) If not, please sign and return the Form to the email address above

2. Did the Contractor and their employee(s) meet your agency /company’s requested service needs and work plan? Yes☐ No☐

i) If not, please provide details below:

3. Was the project performed by this Contractor completed within the agreed-upon time?

Yes☐ No☐

i) If no, please provide details below:

4. Was the project completed within budget? Yes☐ No☐

Ed Green

Hazardous Material Coordinator

Arizona Department of Transportation egreen@azdot.gov

602.920.3882 mailto:Forbin.Merrilyn@azdeq.gov

Page | 2 Rev.12-18-2018

i) If not, please provide details on how the supplier communicated and managed the cost overrun.

5. Please describe the quality of deliverables submitted:

6. Did any of your external stakeholders file a performance or conduct report against the contractor or any of their staff? Yes☐ No☐

ii) If yes, please provide details below

7. Was the Contractor’s staff responsive to solving any problems that may have occurred on your project?

8. Would you be willing to contract with this Contractor again? Yes☐ No☐

i) If yes, please provide a rating from 0 to 6:

9. Was there any finding of inaccuracies in the data provided by the Contractor? Yes☐ No☐

If yes please provide details below

10. How would you rate the Contractor’s overall job performance?

Unsatisfactory☐ Marginal☐ Satisfactory☐ Very Good☐ Exceptional☐

To the Arizona Department of Environmental Quality: The undersigned has certified all information contained in the Past Performance Questionnaire is current and factual.

Name: ____________________________

Title: _____________________________

Signature: ____________________________

Date: ________________________________

Ed Green

Hazardous Material Coordinator 31 Jan 2023