PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor's Name: ____________________
Address: ____________________
            ____________________
            ____________________
            ____________________

Telephone Number: ______________________
Fax Number: ___________________________
Point of Contact: ________________________

(The government enters the following information based on list of references provided by the offeror. The offeror will enter this information if the solicitation requires him to submit questionnaires to the references.)

Project Title and Brief Description of Work: _____________________________________*

________________________________________________________________________*

Contract Number Provided by Offeror: ___________________ Dollar Amount: ________*

Contract Period or Dates of Performance Provided by Offeror: ______________________*

Contractor performed as the  Prime Contractor  Sub-Contractor  Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: ____________________
Address: ________________________
________________________________
________________________________

Title: ____________________
Telephone Number: _____________________
Fax Number: ___________________________
Email Address: __________________________

C. FAX COMPLETED SURVEY FORM TO: ___________________________________________

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor's performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E	G	S	M	U	N
Exceptional	Good	Satisfactory	Marginal	Unsatisfactory	Neutral
Performance meets contractual requirements with many exceeded to the Government's benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.	Performance meets contractual requirements with some exceeded to the Government's benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.	Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.	Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.	Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor's corrective actions appear or were ineffective.	Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR'S NAME: _______________ CONTRACT NUMBER: _______________

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an "X" in the appropriate column using the definitions matrix above.

	The contractor:	E	G	S	M	U	N
1.	Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.
2.	Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.
3.	Delegated authority to project managers and supervisors commensurate with contract requirements.
4.	Home office participated in solving significant local problems.
5.	Followed approved quality control plan.
6.	Provided effective quality control and/or inspection procedures to meet contract requirements.
7.	Corrected deficiencies in timely manner and pursuant to their quality control procedures.
8.	Provided timely resolution of contract discrepancies.
9.	Identified problems as they occurred.
10.	Suggested alternative approaches to problems.
11.	Displayed initiative to solve problems.
12.	Developed realistic progress schedules.
13.	Met established project schedules.
14.	Provided timely resolution of warranty defects.
15.	Was responsive to contract changes.
16.	Provided adequate project supervision.
17.	Obtained consent of surety for increases in bonding as work-in-progress increased.
18.	Paid subcontractors/suppliers in a timely manner.
19.	Provided accurate and complete line item cost proposals including all aspects of work required for each task.
20.	Cooperated with Government personnel after award.
21.	How would you rate the contractor's overall performance?
22.	Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in "remarks."				YES/NO
23.	Would you award another contract to this contractor? If not, explain in "remarks."				YES/NO
24.	Is the contractor rated in CPARS?				YES/NO

CONTRACTOR'S NAME: ___________________ CONTRACT NUMBER __________

Remarks: _____________________________________________________________________________________

_____________________________________________________________________________________

Note: While these questions are generic and will work as written in many acquisitions, consider them as they relate to each individual acquisition and tailor them as needed and appropriate. Also, when tailoring the form, consider leaving space between questions for comments.