Reference Check Past Performance Questionnaire-Veolia (1).pdf

Page | 1 Rev.12-18-2018

REQUEST FOR PROPOSAL (RFP) # BPM004287

ADEQ Project: “Lead Service Line Consultant Services”

Past Performance Questionnaire

Contractor: 120 WATER AUDIT INC.

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

Reference Check provided by

Name __Carol Walczyk____________________________________________________________________

Title_____Vice President___________________________________________________________________

Agency/Company______Veolia North America________________________________________________

Email

Address________carol.walczyk@veolia.com___________________________________________________

Phone Number ___201-708-5485_________________________________________________________

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: 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:

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.

mailto:Forbin.Merrilyn@azdeq.gov

Page | 2 Rev.12-18-2018

5. Please describe the quality of deliverables submitted:

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?

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

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

Title: ___Vice President_____________________

Signature: ____Carol Walczyk________________

Date: ______10/14/2022_____________________