Solicitation 89503122QWA000186 Attachment 5 - Past Performance Questionnaire.docx

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WAPA DSW: Heavy Equipment Inspection Services - Amendment 0001
Solicitation number
89503122QWA000186
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WAPA DSW Heavy Equipment Inspections Solicitation 89503122QWA000186 Attachment 5

DEPARTMENT OF ENERGY

WESTERN AREA POWER ADMINISTRATION

DESERT SOUTHWEST REGION (DSW)

PAST PERFORMANCE

QUESTIONNAIRE

Solicitation # 89503122QWA000186

SECTION I. CONTRACT IDENTIFICATION

CONTRACTOR NAME:
CONTRACT NO:

CONTRACTOR ADDRESS:

CONTRACT TYPE:

|_| FIRM-FIXED-PRICE

|_| COST REIMBURSEMENT

|_| OTHER: (specify)

|_| ACTIVE |_| COMPLETED

|_| ROUTINE |_| COMPLEX

DATES OF PERFORMANCE:

AWARD AMOUNT: $

TOTAL WITH MODS $

PROJECT DESCRIPTION: Heavy Equipment Inspection Services

SECTION II. AGENCY (CUSTOMER) IDENTIFICATION

AGENCY (CUSTOMER) NAME: Department of Energy, Western Area Power Administration, Desert Southwest Region

POC NAME/TITLE/PHONE: Tim Kramer/Contract Specialist/602-605-2685 Kramer@WAPA.GOV

SECTION III. PAST PERFORMANCE RATING

Rating Scale:E = Excellent. Considerably surpassed requirements/expectations.
G = Good. Surpassed requirements/expectations.
S = Satisfactory. Met requirements/expectations
M = Marginal. Met some requirements/expectations

U = Unsatisfactory. Did not meet requirements/expectations

1. QUALITY:
(Circle applicable rating)
a. Conformance with contract requirements
E G S M U
b. Quality of workmanship (including subcontractors)
E G S M U
c. General oversight by project manager and superintendent
E G S M U
d. Coordination with and control of subcontractors
E G S M U
e. Compliance with Davis-Bacon or other wage rate and labor usage requirements
E G S M U
f. Avoidance of accidents/safety violations
E G S M U

2. TIMELINESS:

a. Adherence to project delivery schedules
E G S M U
b. Submission of change proposals
E G S M U
c. Response to technical direction and change orders
E G S M U
d. Response to correction of identified problems
E G S M U
e. Submission of timely/accurate/complete billings
E G S M U
f. Submission of materials/other submittals
E G S M U

3. BUSINESS RELATIONS:

a. Flexibility and cooperativeness in resolving problems
E G S M U
b. Tenacity and innovativeness in resolving problems
E G S M U
c. Relationships with subcontractors, including prompt payment
E G S M U
d. End user was satisfied with services performed
E G S M U

SECTION IV. COMMENTS FOR M = MARGINAL AND U = UNSATISFACTORY RATINGS

Item No.
Comment
PRINTED NAME: __________________________________
DATE:_______________

SIGNATURE: ______________________________________

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