J-1-3_Past_Performance_Questionnaire.doc

PAST PERFORMANCE QUESTIONNAIRE

1. Please complete this questionnaire based on the following guidance:

1.1. Handwritten responses are sufficient.

1.2. Indicate, based on the codes below, the contractor’s performance on the identified program. Assessments should reflect only contractor liable performance. The following is a definition of the scoring levels:

Performance Level

CODE

EXCEPTIONAL

(E) Indicates that the contractor’s performance within the area of evaluation clearly exceeds contractual requirements.

SATISFACTORY

(S) Indicates no problems exist in the area of evaluation or has only minor problems for which solutions are in hand.

MARGINAL

(M) Indicates the area of evaluation contains an existing problem for which there is doubt whether the identified solution is adequate but the problem appears to be within the contractor’s ability to solve.

UNSATISFACTORY

(U) Indicates a serious problem exists in the evaluation area which may be outside the contractor’s ability to solve. The contractor is in danger of not being able to satisfy contractual requirements and timely recovery in not likely.

NOT APPLICABLE

(N/A) Performance did not include such efforts or performance was not observed.

1.3. Please circle a letter corresponding to your rating or ‘N/A’ if you are unable to provide a rating for an area.

1.4. FOR ANY RATING BELOW SATISFACTORY, A CLARIFICATION AND EXPLANATION IS REQUESTED. IF MORE SPACE IS NEEDED, USE THE BACK OF THIS QUESTIONNAIRE.

1.5. You are urged to supplement your knowledge of the contractor’s performance with the judgment of others in your organization. In addition to completing the attached questionnaire for the identified program, we solicit your comments on other similar programs for which your activity has contracts with this offeror.

1.6. Please return completed questionnaire to the requestor in a sealed envelope with the responder’s signature over the seal.

If you have any questions, please refer to the point of contact(s) section in the FedBizOpps announcement.

PROGRAM IDENTIFICATION

A. CONTRACTOR: -

(Company name/Division)

B. CONTRACT NUMBER: -

C. CONTRACT EFFORT OR PROGRAM TITLE: __________________________________________________________________________________________________________________________

D. BRIEF DESCRIPTION OF CONTRACT EFFORT OR TASK:

E. CONTRACT TYPE: ________________________________________

(FIXED PRICE/COST REIMBURSABLE OR OTHER)

F. ESTIMATED AMOUNT/ANNUAL VOLUME OF SERVICE:

G. PERIOD OF PERFORMANCE: _____________________________-

PAST PERFORMANCE EVALUATION

I. MANAGEMENT ABILITY

1. The contractor provided experienced executives, E S M U N/A including project manager and supervisors and replacements with the technical and administrative qualifications required to meet the contract requirements.

2. The contractor’s delegation of authority to E S M U N/A project manager and supervisors met contract requirements.

3. The contractor provided adequate resources E S M U N/A

(personnel/equipment) in each specialty necessary to fulfill contractual requirements.

4. The contractor provided effective emergency E S M U N/A response actions and corrective actions to cover incidents such as: disruption of utilities, accidents, material shortages, safety, security, and hazardous materials handling incidents.

II. BONDING POTENTIAL

Contractor met initial bonding requirements

E S M U N/A and provided consent of surety for increased bonding as work-in-progress increased.

III. QUALITY CONTROL

1. Contractor provided effective Quality/

E S M U N/A

Inspection procedures and personnel to meet contract requirements.

2. When deficiencies were reported, the contractor E S M U N/A took effective corrective actions pursuant to their

Quality Control procedures.

3. Contractor completed projects and subsequent E S M U N/A corrective actions, including punch-list items, in a timely manner.

IV. SUBCONTRACTORS

1. Contractor paid subcontractors in a timely E S M U N/A manner.

V. COST/PRICE

1. The contractor provided accurate and timely E S M U N/A proposals for change orders.

VI. GENERAL

Given the opportunity, would your organization

Yes

No enter a contractual relationship with this contractor in the future?

VII. RESPONSE INFORMATION

THE FOLLOWING INFORMATION WILL ASSIST IN THE ANALYSIS OF THE DATA. THIS INFORMATION WILL BE KEPT CONFIDENTIAL.

A. Name of evaluator: ______________________________________________

B. Office symbol address: ___________________________________________

C. Phone/FAX/Email: ______________________________________________

D. Position/Title: __________________________________________________

E. Length of involvement in Program/Contract: __________________________

F. Source of Information/Documentation utilized to rate Performance Level:___________________________________

G. Date Questionnaire Completed: ____________________________________

VIII. COMMENTS

NOTE: ADDITIONAL COMMENTS ARE ENCOURAGED.

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