pastperformancequestionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

SOL-DC-14-00002

S O U R C E S E L E C T I O N S E N S I T I V E I N F O R M A T I O N

Name of Offeror:

CONTRACT INFORMATION

Name of Contractor: Contract Number: Contract Title: Contract Value:

Type of Contract: Period of Performance:

The ratings below are supplied by the contractor identified above, NOT the offeror.

Performance Elements

Totally Deficient

Poor

Inadequate

Adequate

Good

Superior

1. Quality of Product or Service

2. Timeliness of Performance

3. Effectiveness of Management

4. Initiative in Meeting Requirements

5. Response to Technical Direction

6. Responsiveness to Performance Problems

7. Compliance with Cost Estimates

8. Customer Satisfaction

9. Overall Performance

10. Remarks on superior performance: (Provide data supporting this observation; you may continue on a separate sheet if needed.)

11. Remarks on unsatisfactory performance: (Provide data supporting this observation; you may continue on separate sheet if needed.)

12. Please identify any corporate affiliations with the offeror.

13. Would you do business with this firm again?

14. Information provided by:

Name:

Title:

Mailing Address (Street and PO Box):

City, State, and Zip Code:

Telephone number:

Fax number:

E-mail Address:

Time of Call:

Date Information provided:

15. Questionnaire completed by:

Name of EPA Employee: Title: Signature of EPA Employee:

Date Questionnaire Completed: