Past_Performance_Questionnaire_2019.docx

Attachment J.3

PAST PERFORMANCE QUESTIONAIRE

Source Selection Information – Sensitive

The offeror is required to electronically complete the top portion (only) of Attachment J.3, Past Performance Questionnaire. The offer will then send the questionnaire to the respective organization and request that the completed questionnaire be e-mailed to the Contract Specialist at [bundy.myla@dol.gov] no later than [The due date of the RFP].

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

Offeror (Company Name):

Customer (Reference):

Customer Phone Number:

Contract Number:

Period of Performance:

Brief Description of Contract/Requirement:

NAICS Code (if applicable):

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

The ratings below are to be provided by the organization identified above, and submitted to the Contract Specialist at the following email address: bundy.myla@dol.gov. 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 offeror. Ratings to be used are: Exceptional, Very Good, Satisfactory, Marginal, and Neutral. Ratings should be supported with the appropriate comments. Anything less than an overall rating of satisfactory will constitute an unacceptable level of risk. Neutral ratings for past performance will be assigned when there is no past performance history available. Neutral ratings will not penalize the offeror and will result in the offerors 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 offeror 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 Rating: Choose an item.

Comments:

2. Timeliness of Performance

Comments:

3. Business Relations

Comments:

4. Personnel Management

5. Subcontractor Management

6. Overall Performance

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

8. Questionnaire completed by:

Name/Title

Mailing Address

City, State, Zip

Phone Number

Email Address

Date

Signature