B3.0_W9126G-16-R-0074_APPENDIX_E_(R).pdf

APPENDIX E

(Revised 5/3/2016)

PAST PERFORMANCE QUESTIONNAIRE

SOURCE SELECTION INFORMATION

REAL ESTATE SUPPORT SERVICES

SOUTHWESTERN DIVISION (SWD)

FORT WORTH DISTRICT (SWF)

W9126G-16-R-0074

FOR OFFICIAL USE ONLY

Name of Contractor: __________________________________________________

Contract Information

Name of Reference Organization: __________________________

Contract No: __________________

Contact Title: ______________________________________

Contract Value: ____________________

Type of Contract: ________________________________

Period of Performance: _________________

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

Performance Elements

Excellent

Good

Satisfactory

Marginal

Unsatisfactory

Not Applicable

1. Quality of Product or Service

2. Timeliness of Performance

3. Effectiveness of Management (including subcontractors)

4. Response to Technical Direction

5. Responsiveness to Performance Problems

6. Overall Performance

1. Remarks on excellent performance: (Provide data supporting this observation. You may continue on a separate sheet if needed.)

2. Remarks on unsatisfactory performance: (Provide data supporting this observation. You may continue on a separate sheet if needed.)

3. Please identify any corporate affiliations with the contractor.

4. Would you do business with

______________________________________________again? YES NO (Insert contractor’s name) (Circle one)

5. Information provided by:

Name Mailing address (Street and P.O. Box)

Title City, State and Zip Code

Time of Call Telephone and Fax Numbers

6. Questionnaire completed by:

Signature and Title of COE Employee Date

Please email the completed Questionnaire to:

James Hill Contract Specialist

USACE-CESWF- CT

819 Taylor St., Rm 2A19 Fort Worth, TX 76102-0300 Phone: 817-886-1271 Email: james.t.hill@usace.army.mil mailto:james.t.hill@usace.army.mil