J-7 (Past Performance Questionnaire).docx
DOCX document 31 KB Posted
- Attached to
- Operation of the Los Angeles Job Corps Center
- Solicitation number
- 1605JW-23-R-00009
About this file
This document is a past performance questionnaire for a federal contractor responding to solicitation number 1605JW-23-R-00009 from the Department of Labor Employment and Training Administration for the operation of the Los Angeles Job Corps Center. The contractor is seeking references from prior clients to submit as part of its response, which is due by the specified date and time. The questionnaire collects information on outcomes achieved, cost control, timeliness, business relations, and customer satisfaction for the identified past contract. Respondents are asked to provide adjectival ratings and explanations in these areas. Upon completion, the form is to be returned directly to the Department of Labor contact for consideration in the source selection process.
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ATTACHMENT J-7 - Past Performance Questionnaire
To Whom it May Concern:
_______________ Company is currently responding to the U. S. Department of Labor RFP #DOL_____________ for the procurement of the continued operation of the ________Job Corps Center.
The U. S. Department of Labor is placing increased emphasis in their procurements on past performance as a source selection factor. They are requiring that clients of entities responding to their solicitations be identified and their participation in the evaluation process be requested. Therefore, we are requesting that you provide the following information regarding our performance on the contract identified below. Please complete Sections B-F of this Questionnaire and return it directly to the address shown below no later than ________ a.m./p.m., ______________, 2012.
ATTN: __________________
Office of Contracts Management (OCM)
U.S. DOL – ETA
E-mail__________________________
By my signature below, I authorize you to respond to any additional inquiries by the U. S. Department of Labor regarding our performance on the referenced contract.
(Signature) (Date)
(Title)
A. Past Performance
A. Contract Identifying Information:
Offeror:
Project Title & Contract Number:
Contracting Officer:
Phone No.
| Project Manager: |
| Phone No. |
Address:
FAX No.
Work Performance Period: _____________________ to ______________________
Contract Value: $
Brief Summary of Statement of Work:
B. Outcomes vs. Goals:
| 1. | Were there measurable performance goals or outcomes associated with this contract? If yes, describe: |
| Yes |
No
For the following questions, where applicable, check the adjectival rating which most closely represents your assessment of the contractor's performance: Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory
| 2. | How effective was the contractor in achieving those outcomes? (Explain any rating below Satisfactory) |
| Exceptional |
Very Good Satisfactory Marginal Unsatisfactory
C. Cost Control: How well has the contractor:
| 1. | Performed all contracted services within the budget? |
| Exceptional |
Very Good Satisfactory Marginal Unsatisfactory
| 2. | Submitted complete and accurate financial reports and invoices? |
| Exceptional |
Very Good Satisfactory Marginal Unsatisfactory
3. Has a draft or final audit report disclosed questioned or disallowed costs? If yes, indicate:
· period covered by audit
· disallowed or recommended for disallowance
· disallowed costs as a % of audited funds Yes No
Comments: (Explain any ratings below Satisfactory)
Summary Adjectival Rating of Cost Control Exceptional Very Good Satisfactory Marginal
D. Timeliness of Performance: How well has the contractor:
| 1. | Completed contract requirements and submitted reports and schedules according to specified time frames? | |
| Exceptional | Marginal | |
| Very Good | Unsatisfactory |
Satisfactory
| 2. | Responded to technical direction and requests in a timely manner? | |
| Exceptional | Marginal | |
| Very Good | Unsatisfactory |
Satisfactory
| Comments: (Explain any ratings below Satisfactory) |
| Summary Adjectival Rating of Timeliness of Performance |
| Exceptional | Marginal |
| Very Good | Unsatisfactory |
Satisfactory
E. Business Relations: To what extent has the contractor:
| 1. | Been pro-active in contract monitoring and review? | |
| Exceptional | Marginal | |
| Very Good | Unsatisfactory |
Satisfactory
| 2. | Demonstrated a responsive and cooperative working relationship with the Contracting Officer and Project staff? |
| Exceptional | Marginal |
Very Good Unsatisfactory Satisfactory
| 3. | Promptly notified the Contracting Officer of potential problems? |
| Exceptional | Marginal |
Very Good Unsatisfactory Satisfactory
| 4. | Used effective approaches and provided technical expertise and resources to solve contract problems? |
| Exceptional | Marginal |
Very Good Unsatisfactory Satisfactory
| Comments: (Explain any ratings below Satisfactory) |
| Summary Adjectival Rating of |
Business Relations
Exceptional Marginal Very Good
Satisfactory
F. Customer Satisfaction: To what extent has the contractor:
| 1. Been effective in tailoring the program to meet the needs of the customers? |
| Exceptional |
Very Good Satisfactory Marginal Unsatisfactory
2. Shown flexibility in operating the program to meet changing program needs and emphases?
Exceptional Very Good Satisfactory Marginal Unsatisfactory
| Comments: (Explain any ratings below Satisfactory) |
| Summary Adjectival Rating of |
Customer Satisfaction
Exceptional Very Good Satisfactory Marginal
Additional Comments:
Name & Title of Individual Completing Information:
Phone No.
(For Department of Labor Use Only)
SUMMARY PAST EXPERIENCE CONFIRMATION
B. Outcomes vs. Goals
C. Cost Control
D. Timeliness of Performance
E. Business Relations
F. Customer Satisfaction
Verified by:___________________________________________Date:____________________
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