Attachment_07_Past_Performance_Questionaire.docx

Attachment 07 – Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify): Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

Contractor Information (Firm Name): Client Information (Name):

TO BE COMPLETED BY THE CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

1. QUALITY:

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

3. CUSTOMER SATISFACTION:

4. MANAGEMENT/ PERSONNEL/LABOR

5. COST/FINANCIAL MANAGEMENT

6. SAFETY/SECURITY

b) Contractor complied with all security requirements for the project and personnel security requirements.

7. GENERAL

Please provide comments to any questions above that is rated as Unacceptable. In addition, provide any additional remarks that you may have about the contractor.