Attachment_5_Past_Performance_Questionnaire.pdf

SOL-CI-15-00021

Attachment 5

Past Performance Questionnaire

ATTACHMENT 5

PAST PERFORMANCE QUESTIONNAIRE

Offeror shall fill out top portion and send to Reference Organizations:

Name of Offeror Proposing on EPA Requirement: __________________________________________________

Brief Description of this Project and Relevance to the EPA Project: ___________________________________ Name of Reference’s Organization: ______________________________________________________________ Contract Title: ________________________________________________________________________________ Contract Number: _________________________________ Contract Value: _____________________________

Type of Contract: _______________________________Period of Performance: __________________________

The ratings indicated below are to be supplied by the reference identified above and not the offeror.

Performance Elements

Exceptional (See Question 5)

Very Good Satisfactory Marginal Unsatisfactory

Technical

Schedule

Management

* Management, including subcontracts; reasonable/cooperative behavior; responsive to contract requirements; notification of problems; flexibility; proactive versus reactive.

5. Remarks on Exceptional Performance:

(Provide data supporting this observation. You may continue on a separate sheet if needed.)

6. Remarks on Unsatisfactory Performance:

(Provide data supporting this observation. You may continue on a separate sheet if needed.)

SOL-CI-15-00021

Attachment 5

Past Performance Questionnaire

7. Other Comments:

(You may continue on a separate sheet if needed.)

8. Please identify any corporate affiliations with the offeror, if any.

9. Questionnaire completed by:

Name of Evaluator __________________________

Title __________________________ Date __________________________ Address __________________________ Phone number __________________________ Email: __________________________

Please submit your completed Past Performance Questionnaire DIRECTLY to the U.S. EPA Contract Specialist, Angela Lower, via email lower.angela@epa.gov, not later than 4:30PM EST on August 4, 2015. If you have any questions, please contact Mrs. Lower at (513) 487- 2036.