Reference Check Past Performance Questionnaire_Filled-Out (1).pdf

Page | 1 Rev.12-18-2018

REQUEST FOR PROPOSAL (RFP) # BPM004287

ADEQ Project: “Lead Service Line Consultant Services”

Past Performance Questionnaire Contractor: Hazen and Sawyer

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

Reference Check provided by

Name ____________________________________________________________________________

Title______________________________________________________________________________

Agency/Company___________________________________________________________________

Email Address_____________________________________________________________________

Phone Number ____________________________________________________________________

1. Has the Contractor listed above provided Lead Service Line Identification and Inventory 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 the 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:

Please provide a rating from 0 to 6:

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

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

Ashley Waldron

Engineering III

City of Englewood

AWaldron@englewoodco.gov

315-790-4387 mailto:Forbin.Merrilyn@azdeq.gov

Page | 2 Rev.12-18-2018

5. Please describe the quality of deliverables submitted:

Please provide a rating from 0 to 6:

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

If yes please provide details below

7. 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

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

Please provide a rating from 0 to 6:

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

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

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: ________________________________

Ashley Waldron

Engineering III 10/13/2022