SIR Attachment 3 - Past Performance Survey.doc

PAST PERFORMANCE

EVALUATION SURVEY

A. Contractor’s name and address:

B. Contractor Point of Contact (Name and Title):

C. Phone number (including area code):

D. Contract No.:

E. Project Title:

Description of the Work Performed:

F. Contract Award Date: ___________________ Completion Date (Must Be Completed within the last five years):_________________

G. Contract Award Amount: __________________ Final Contract Amount: _________________

(Must be at least $150K to be considered Relevant) H. Contractor being evaluated performed as the FORMCHECKBOX Prime Contractor FORMCHECKBOX Subcontractor

I. Respondent Information:

Name:

Organization:

Phone Number:

Email:

J. Authorization is hereby granted to the respondent listed above in section J to provide the information requested in Section B of this survey.

(Signature)

(Name & Title of Authorizing Official) (Date)

SECTION A: CONTRACTOR INFORMATION (to be completed by the contractor requesting evaluation prior to mailing) SECTION B: RESPONDENT INFORMATION (to be completed by respondent) *Note: The identity of individual(s) providing reference information shall not be disclosed.

LESS FAVORABLE

MORE FAVORABLE

EVALUATION AREAS

(Circle the appropriate response – if Not Applicable insert N/A next to the statement)

1. Quality

a. Contractor provided effective quality control and inspection procedures which resulted in a quality performance.

2. Timeliness of Performance

a. Contractor met established schedules to complete the contract on time, as scheduled.

b. The contractor met expected delivery response times.

3. Project Management

a. Contractor acted promptly to resolve problems, ensuring compliance with contract requirements.

b. Contractor was reasonable and cooperated to resolve problems, attended meetings as needed and maintained communication.

c. Contractor provided experienced/qualified managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

4. Customer Satisfaction

a. Contractor responded to customer service requests in a timely manner.

b. Contractor displayed flexibility in responding to your needs.

c. Displayed initiative and innovation in problem solving

d. Resolved your concerns.

Overall Past Performance Rating

Comments: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

EVALUATED BY:

(Signature) (Date)

(Typed or Printed Name)

(Title)