Attachment__2_PP_Questionnaire.doc

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Scientific Health and Environmental Assessment and
Solicitation number
SOL-DC-14-00041
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Past Performance Questionnaire

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Attachment #2

Past Performance Questionnaire

SOURCE SELECTION SENSITIVE INFORMATION

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
FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

2. Timeliness of Performance
FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

3. Effectiveness of Management
FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

4. Initiative in Meeting Requirements
FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

5. Response to Technical Direction
FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

6. Responsiveness to Performance Problems
FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

7. Compliance with Cost Estimates
FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

8. Customer Satisfaction
FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

9. Overall Performance
FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

FORMCHECKBOX

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 a 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 of information provided:

15. Questionnaire completed by:

Name of EPA Employee:

Title of EPA Employee:

Signature of EPA Employee:

Date Questionnaire Completed:

File details come from the government source that posted it. Updated .