Attachment_9_PAST_PERFORMANCE_QUESTIONNAIRE.pdf

ATTACHMENT 9

PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE

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 (also to be supplied by offeror to EPA in proposal)

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. Business Relations

4. Cost Control

5. Customer Satisfaction

6. Remarks on superior performance:

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

7. Remarks on totally deficient performance:

(Provide data supporting this observation; you may continue on separate sheet if needed.)

8. Please identify any corporate affiliations with the offeror:

9. Would you do business with __________________________ again?

(insert offeror's name)

10. Information provided by:

Name of individual _____________________

Signature __________________________

Title_________________________

Date__________________________

Mailing Address__________________________

City, State and Zip Code_______________________________

Telephone and Fax Numbers____________________________