Attachment_J3_-_PAST_PERFORMANCE_QUESTIONAIRE.docx

PAST PERFORMANCE QUESTIONAIRE

Source Selection Information – Sensitive

SECTION 1: THIS SECTION IS TO BE COMPLETED BY THE OFFEROR**

Offeror (Company that will be submitting a proposal to DOL):

Customer (Reference):

Contract Number:

Period of Performance:

Brief Description of Contract/Requirement:

NAICS Code (if applicable):

** THIS SECTION IS TO BE COMPLETED BY THE PAST PERFORMANCE REFERENCE**

The ratings below are to be provided by the organization identified above, and submitted to the Contract Specialist provided to you by the requesting organization. The organization requesting the reference will provide you with the due date and time.

Answers to Questions 1-6 are based on information obtained from the named organization, not the contractor. Ratings to be used are: Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory and Neutral. Ratings should be supported with the appropriate comments. Neutral ratings for past performance may be assigned when there is no past performance history available. Neutral ratings will not penalize the contractor and will result in the contractor’s proposal being further evaluated.

The following chart depicts the ratings that are to be used to evaluate the contractor’s performance:

References should evaluate performance of the contractor identified within this form. Where the reference lacks sufficient information to provide an evaluation for a particular performance element, this should be noted. Where any deficiency or unfavorable information is identified, the reference should identify any mitigating factors that may weigh in favor for the person/firm on whose behalf the reference is provided (i.e., problems due to causes outside the contractor’s control) and provide contractors rebuttal statement. An individual within your organization that is knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

1. Quality of Services: Compliance with contract requirements, effectiveness of contractor’s quality control plan/program, effective and efficient management of work force, work force properly trained and experienced to ensure that required tasks are successfully performed, no adverse actions taken for quality issues, etc.

Rating: Choose an item.

Comments: Click here to enter rationale for the chosen rating.

2. Cost Control: (Does not apply to Fixed Price type contracts) Assess the contractor’s effectiveness in forecasting, managing, and controlling contract/order cost. If the contractor is experiencing cost growth or underrun, discuss the causes and contractor-proposed solutions for the cost overruns or underruns. For contracts/orders where task or contract sizing is based upon contractor-provided person hour estimates, the relationship of these estimates to ultimate task cost should be assessed. In addition, the extent to which the contractor demonstrates a sense of cost responsibility, through the efficient use of resources, in each work effort should be assessed.

Comments: Click here to enter rationale for the chosen rating.

3. Schedule/Timeliness: Assess the timeliness of the contractor against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements (e.g., efforts that contribute to or affect the schedule variance).

Comments: Click here to enter rationale for the chosen rating.

4. Management/Business Relations: Assess the integration and coordination of all activity needed to execute the contract/order, specifically the timeliness, completeness and quality of problem identification, corrective action plans, proposal submittals, the contractor’s history of reasonable and cooperative behavior (to include timely identification of issues in controversy), customer satisfaction, timely award and management of subcontracts. Assess the contractor’s performance in selecting, retaining, supporting, and replacing, when necessary, key personnel.

Comments: Click here to enter rationale for the chosen rating.

5. Small Business Subcontracting: Assess compliance with all terms and conditions in the contract/order relating to Small Business participation (including FAR 52.219-8, Utilization of Small Businesses and FAR 52.219-9, Small Business Subcontracting Plan (when required). Assess any small business participation goals which are stated separately in the contract/order. Assess achievement on each individual goal stated within the contract/order or subcontracting plan including good faith effort if the goal was not achieved.

6. Regulatory Compliance: e.g failure to report in accordance with contract terms and conditions, late or nonpayment to subcontractors, trafficking violations, tax delinquency, defective cost or pricing data, terminations, suspension and debarments) Assess compliance with all terms and conditions in the contract/order relating to applicable regulations and codes, Consider aspects of performance such as compliance with financial, environmental (example: Clean Air Act, Clean Water Act), safety, and labor regulations as well as any other reporting requirements in the contract terms and conditions.

7. Overall Performance

8. Would you do business with this company again? Choose an item.

9. Questionnaire completed by:

Name/Title

Mailing Address

City, State, Zip

Phone Number

Email Address

Date

Signature