**PAST PERFORMANCE QUESTIONNAIRE COVER SHEET**

**FOR SOLICITATION NO. 09SQ600053**

**CHEMICALS FOR LEADVILLE MINE DRAINAGE TUNNEL**

Name of offeror questionnaire is being completed for:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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Name of company completing questionnaire:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Contract Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name, title and phone number of person completing questionnaire:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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Length of time your firm has been involved with the offeror:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**PLEASE FAX YOUR PAST PERFORMANCE COVER SHEET AND QUESTIONNAIRE [BY
PROPOSAL DUE DATE]{.underline} TO:**

U.S. BUREAU OF RECLAMATION

GREAT PLAINS REGIONAL OFFICE

ATTN: SHAWNA ROGERS

P.O. BOX 36900

BILLINGS MONTANA 59107-6900

PHONE - (406) 247-7797

FAX - (406) 247-7798

> YOUR ASSISTANCE IN EVALUATING THE CONTRACTOR=S PAST PERFORMANCE IS
> APPRECIATED. OUR GOAL IS TO SELECT THE BEST VALUE TO THE GOVERNMENT.
> YOUR PAST PERFORMANCE EVALUATION IS A CONSIDERATION IN DETERMINING THE
> BEST VALUE.

**PAST PERFORMANCE QUESTIONNAIRE RATING SHEET**

## SOLICITATION NUMBER: 07SQ600001 

**[RATING SCALE]{.underline}**

Please use the following ratings to answer the questions. If you are
unable to rate an item because it was not a requirement, never an issue,
or you have no knowledge of the item in question, then you should mark
"NA".

**EVALUATION CRITERIA**

**Excellent** - The offeror's performance was consistently superior. The
contractual

> performance was accomplished with only minor problems for which
> corrective
>
> action taken by the contractor was highly effective.

**Good** - The offeror's performance was better than average, and you
would

> willingly do business with the offeror again. The contractual
> performance was
>
> accomplished with minor problems for which corrective actions taken by
>
> the contractor were effective.

**Neutral** - No record exists.

**Average** - The offeror's performance was satisfactory and
consideration would take part in

> awarding a contract to the offeror again. The contractual performance
> reflects a
>
> problem for which the contractor has not yet implemented corrective
> actions.

**Poor** - The offeror's performance was entirely unsatisfactory and you
would not do

> business with the offeror again under any circumstances. The
> contractual
>
> performance being assessed contains problems for which the
>
> contractor's corrective actions appear to be or were ineffective.

**NOTE: For statements indicating "Poor", please provide a brief
explanation**

> **in the comments section of the survey.**

**CONTRACTOR PERFORMANCE EVALUATION SURVEY**

+----------------------------------+------+------+------+----+-------+
|                                  |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
|                                  | POOR | AVE  | NEU  | GO | EXCE  |
|                                  |      | RAGE | TRAL | OD | LLENT |
+----------------------------------+------+------+------+----+-------+
| [a.) QUALITY OF PRODUCT OR       |      |      |      |    |       |
| SERVICE:]{.underline}            |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(1\) The Contractor provided a  |      |      |      |    |       |
| product or service that          |      |      |      |    |       |
| conformed                        |      |      |      |    |       |
|                                  |      |      |      |    |       |
| to contract requirements,        |      |      |      |    |       |
| specifications, and standards of |      |      |      |    |       |
|                                  |      |      |      |    |       |
| good workmanship.                |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(2\) The Contractor submitted   |      |      |      |    |       |
| accurate reports.                |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(3\) The Contractor utilized    |      |      |      |    |       |
| personnel that were appropriate  |      |      |      |    |       |
| to the                           |      |      |      |    |       |
|                                  |      |      |      |    |       |
| effort performed.                |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
|                                  |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| [b.) COST CONTROL:]{.underline}  |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(1\) The Contractor performed   |      |      |      |    |       |
| the effort within the estimated  |      |      |      |    |       |
|                                  |      |      |      |    |       |
| cost/price.                      |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(2\) The Contractor submitted   |      |      |      |    |       |
| accurate invoices on a timely    |      |      |      |    |       |
| basis.                           |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(3\) The Contractor             |      |      |      |    |       |
| demonstrated cost efficiencies   |      |      |      |    |       |
| in performing                    |      |      |      |    |       |
|                                  |      |      |      |    |       |
| the required effort.             |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(4\) The actual costs/rates     |      |      |      |    |       |
| realized closely reflected the   |      |      |      |    |       |
| negotiated                       |      |      |      |    |       |
|                                  |      |      |      |    |       |
| costs/rates.                     |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
|                                  |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| [c.) SCHEDULE:]{.underline}      |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(1\) The tasks required under   |      |      |      |    |       |
| this effort were performed in a  |      |      |      |    |       |
|                                  |      |      |      |    |       |
| timely manner and in accordance  |      |      |      |    |       |
| with the period of               |      |      |      |    |       |
|                                  |      |      |      |    |       |
| performance of the contract.     |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(2\) The Contractor was         |      |      |      |    |       |
| responsive to technical and/or   |      |      |      |    |       |
| contractual                      |      |      |      |    |       |
|                                  |      |      |      |    |       |
| direction.                       |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
|                                  |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| [d.) BUSINESS                    |      |      |      |    |       |
| RELATIONSHIPS:]{.underline}      |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(1\) The Contractor             |      |      |      |    |       |
| demonstrated effective           |      |      |      |    |       |
| management over                  |      |      |      |    |       |
|                                  |      |      |      |    |       |
| the effort performed.            |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(2\) The Contractor maintained  |      |      |      |    |       |
| an open line of communication so |      |      |      |    |       |
|                                  |      |      |      |    |       |
| that the Contracting Officer's   |      |      |      |    |       |
| Representative (COR) and/or      |      |      |      |    |       |
|                                  |      |      |      |    |       |
| Technical Point of Contact       |      |      |      |    |       |
| (TPOC) were apprised             |      |      |      |    |       |
|                                  |      |      |      |    |       |
| of technical, cost, and schedule |      |      |      |    |       |
| issues.                          |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+
| \(3\) The Contractor presented   |      |      |      |    |       |
| information and correspondence   |      |      |      |    |       |
| in                               |      |      |      |    |       |
|                                  |      |      |      |    |       |
| a clear, concise, and            |      |      |      |    |       |
| businesslike manner.             |      |      |      |    |       |
+----------------------------------+------+------+------+----+-------+

  ----------------------------------- ------- --------- --------- ------ -----------
                                      POOR    AVERAGE   NEUTRAL   GOOD   EXCELLENT

  ----------------------------------- ------- --------- --------- ------ -----------

+----------------------------------+------+---+------+------+---+----+---+-------+
| \(4\) The Contractor promptly    |      |   |      |      |   |    |   |       |
| notified the COR, and/or         |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| Contracting Officer in a timely  |      |   |      |      |   |    |   |       |
| manner regarding urgent          |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| issues.                          |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(5\) The Contractor cooperated  |      |   |      |      |   |    |   |       |
| with the Government in providing |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| flexible, proactive, and         |      |   |      |      |   |    |   |       |
| effective recommended solutions  |      |   |      |      |   |    |   |       |
| to                               |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| critical program issues.         |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(6\) The Contractor made timely |      |   |      |      |   |    |   |       |
| award to, and demonstrated       |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| effective management of, its     |      |   |      |      |   |    |   |       |
| subcontractors.                  |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(7\) The Contractor             |      |   |      |      |   |    |   |       |
| demonstrated an effective        |      |   |      |      |   |    |   |       |
| small/small                      |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| disadvantaged business           |      |   |      |      |   |    |   |       |
| subcontracting program.          |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
|                                  |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
|                                  |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| [e.) CUSTOMER                    |      |   |      |      |   |    |   |       |
| SATISFACTION:]{.underline}       |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(1\) The products/services      |      |   |      |      |   |    |   |       |
| provided adequately met the      |      |   |      |      |   |    |   |       |
| needs                            |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| of the program.                  |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(2\) The Contractor was able to |      |   |      |      |   |    |   |       |
| perform with minimal or no       |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| direction from the COR or the    |      |   |      |      |   |    |   |       |
| CO.                              |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(3\) I am satisfied with the    |      |   |      |      |   |    |   |       |
| performance of the Contractor    |      |   |      |      |   |    |   |       |
| under                            |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| this effort.                     |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| [f. GENERAL                      | YES  | N |      | COMM |   |    |   |       |
| QUESTIONS]{.underline}           |      | O |      | ENTS |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(1\) Did the contractor commit  |      |   |      |      |   |    |   |       |
| any safety violations during     |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| the contract period?             |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(2\) Was the tractor and        |      |   |      |      |   |    |   |       |
| trailer capable of meeting DOT   |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| and OSHA regulations?            |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(3\) Was the contractor         |      |   |      |      |   |    |   |       |
| responsive to contract changes?  |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(4\) Was the contractor         |      |   |      |      |   |    |   |       |
| terminated for any reason other  |      |   |      |      |   |    |   |       |
| than                             |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| completion?                      |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(5\) Did the contractor adhere  |      |   |      |      |   |    |   |       |
| to all deliveries?               |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(6\) If any problems surfaced   |      |   |      |      |   |    |   |       |
| during contract performance,     |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| what did the contractor do to    |      |   |      |      |   |    |   |       |
| resolve the issue?               |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(7\) Did the contractor use     |      |   |      |      |   |    |   |       |
| personnel with appropriate       |      |   |      |      |   |    |   |       |
| skills                           |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| and expertise?                   |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(8\) Was the contractor         |      |   |      |      |   |    |   |       |
| cooperative in resolving issues? |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(9\) Did the contractor display |      |   |      |      |   |    |   |       |
| a commitment to customer         |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| satisfaction and a general       |      |   |      |      |   |    |   |       |
| business like concern for the    |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| Interest of their customers?     |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(10\) Was PPE that the          |      |   |      |      |   |    |   |       |
| contractor provided protecting   |      |   |      |      |   |    |   |       |
| the                              |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| employee to the maximum extend?  |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(11\) Did the contractor apply  |      |   |      |      |   |    |   |       |
| sufficient resources to          |      |   |      |      |   |    |   |       |
| efficiently                      |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| Complete the effort?             |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(12\) Has the contractor        |      |   |      |      |   |    |   |       |
| performed other past efforts for |      |   |      |      |   |    |   |       |
| your                             |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| agency/company?                  |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(13\) What are the company's    |      |   |      |      |   |    |   |       |
| strong points?                   |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(14\) What are the company's    |      |   |      |      |   |    |   |       |
| weak points?                     |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+
| \(15\) Do you have any           |      |   |      |      |   |    |   |       |
| reservation about recommending a |      |   |      |      |   |    |   |       |
| future                           |      |   |      |      |   |    |   |       |
|                                  |      |   |      |      |   |    |   |       |
| contract award to this company?  |      |   |      |      |   |    |   |       |
+----------------------------------+------+---+------+------+---+----+---+-------+