C-02 _13-R-0007 _Attachment_3 _PastPerformanceClientForm.docx
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- Attached to
- FY 2013 ITALY Multiple Award Task Order Contract (MATOC) Federal contract opportunity
- Solicitation number
- W912GB13R0007
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W912GB-13-R-0007 Attachment 3 Past Performance Client Form
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USACE PAST PERFORMANCE QUESTIONNAIRE ATTACHMENT 3
CONTRACT INFORMATION (Contractor to complete Blocks 1-4)
1. Contractor Information Firm Name:
Address:
Phone Number:
Email Address:
| Point of Contact: | Contact Phone Number: |
| CAGE Code: |
DUNS Number:
2. Work Performed as: ❑ Prime Contractor Percent of project work performed:
If subcontractor, who was the prime (Name/Phone #):
| ❑ Sub | |
| Contractor | ❑ Joint |
| Venture | ❑ Other (Explain) |
3. Contract Information Contract Number:
Delivery/Task Order Number (if applicable):
❑ Other (Please specify):
Contract Type: ❑ Firm Fixed Price ❑ Cost Reimbursement 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:
| 4. Project Description: | ||
| Complexity of Work ❑ High | ❑ Med | ❑ Routine |
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:
NOTE: USACE REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO USACE WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON USACE SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO USACE. PLEASE CONTACT THE OFFEROR FOR USACE POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM
TO BE COMPLETED BY CLIENT - ATTACHMENT 3
PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR'S PERFORMANCE.
E = EXCELLENT, VG = VERY GOOD, S = SATISFACTORY, M = MARGINAL,
U = UNSATISFACTORY, N= NOT APPLICABLE
1. QUALITY:
| a) Quality of technical data/report preparation efforts |
| E |
| VG |
| S |
| M |
| U |
| N |
| b) Ability to meet quality standards specified for technical performance |
| E |
| VG |
| S |
| M |
| U |
| N |
| c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance |
| E |
| VG |
| S |
| M |
| U |
| N |
| d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance) |
| E |
| VG |
| S |
| M |
| U |
| N |
2. SCHEDULE/TIMELINESS OF PERFORMANCE:
| a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below) |
| E |
| VG |
| S |
| M |
| U |
| N |
| b) Rate the contractor's use of available resources identified in the contract |
| E |
| VG |
| S |
| M |
| U |
| N |
3. CUSTOMER SATISFACTION:
| a) To what extent were the end users satisfied with the project? |
| E |
| VG |
| S |
| M |
| U |
| N |
| b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication) |
| E |
| VG |
| S |
| M |
| U |
| N |
| c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer? |
| E |
| VG |
| S |
| M |
| U |
| N |
| d) Overall customer satisfaction |
| E |
| VG |
| S |
| M |
| U |
| N |
4. MANAGEMENT PERSONEL/LABOR:
| a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force. |
| E |
| VG |
| S |
| M |
| U |
| N |
| b) Ability to hire, apply, and retain a qualified workforce to this effort |
| E |
| VG |
| S |
| M |
| U |
| N |
| c) Government Property Control |
| E |
| VG |
| S |
| M |
| U |
| N |
| d) Knowledge/expertise demonstrated by contractor personnel |
| E |
| VG |
| S |
| M |
| U |
| N |
| e) Utilization of Small Business concerns |
| E |
| VG |
| S |
| M |
| U |
| N |
| f) Ability to simultaneously manage multiple projects with multiple disciplines |
| E |
| VG |
| S |
| M |
| U |
| N |
| g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes |
| E |
| VG |
| S |
| M |
| U |
| N |
| h) Effectiveness of overall management (including ability to effectively lead, manage and control the program) |
| E |
| VG |
| S |
| M |
| U |
| N |
E = EXCELLENT, VG = VERY GOOD, S = SATISFACTORY, M = MARGINAL,
U = UNSATISFACTORY, N= NOT APPLICABLE
5. COST/FINANCIAL MANAGEMENT
| a) Ability to meet the terms and conditions within the contractually agreed price(s) |
| E |
| VG |
| S |
| M |
| U |
| N |
| b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client |
| E |
| VG |
| S |
| M |
| U |
| N |
| c) If this is/was a Government cost type contract, please rate the Contractor's timeliness and accuracy in submitting monthly invoices with appropriate backup documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns) |
| E |
| VG |
| S |
| M |
| U |
| N |
| d) Is the Contractor's accounting system adequate for management and tracking of costs? If no, please explain in Remarks section. |
| E |
| VG |
| S |
| M |
| U |
| N |
| e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below. |
| E |
| VG |
| S |
| M |
| U |
| N |
f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.
YES
NO
6. SAFETY/SECURITY
| a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.) |
| E |
| VG |
| S |
| M |
| U |
| N |
| b) Contractor complied with all security requirements for the project and personnel security requirements. |
| E |
| VG |
| S |
| M |
| U |
| N |
7. GENERAL
| a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues). |
| E |
| VG |
| S |
| M |
| U |
| N |
| b) Compliance with contractual terms/provisions (explain if specific issues) |
| E |
| VG |
| S |
| M |
| U |
| N |
c) Would you hire or work with this firm again? (If no, please explain below)
YES
NO
| d) In summary, provide an overall rating for the work performed by this contractor. |
| E |
| VG |
| S |
| M |
| U |
| N |
Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (attach additional pages if necessary):
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