Attachment_4_-_Past_Performance_Questionnaire_FINAL.pdf

Attachment 4 - Past Performance Questionnaire

1625DC-19-R-00001

Source Selection Information – See FAR 2.101 and 3.104

PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN, THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION

IAW FAR 2.101 AND 3.104

TO: Government agency or commercial organization (i.e., customer) with knowledge of the Offeror's past performance.

Please complete this questionnaire, which concerns the past performance of a contractor or subcontractor who is doing business (or has done business) with you, and is interested in doing business with the U.S.

Department of Labor (DOL). Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages. Responses will be treated as source selection sensitive information. The contractor who provided DOL with your name as a reference was informed, via a solicitation provision, that by listing you as a reference and requesting your submission of the questionnaire, they are authorizing you to release information to DOL relative to their past performance, whether it is positive or negative information.

Email the completed questionnaire to the attention of the responsible Contracting Officer

(DASASRFP@bls.gov). The Offeror must fill in the solicitation number, fax number, email address, and name of Contracting Officer below, prior to providing you with the questionnaire, or provide you with the information to fill in. Your completed questionnaire must be provided directly to the

Contracting Officer from you. DOL will not accept completed questionnaires sent from the Offeror.

mailto:DASASRFP@bls.gov

Offeror: Complete SECTION 1, then e-mail questionnaire to the customer points of contact listed on the Past Performance Information Sheet for the contract identified.

Offeror’s Evaluator: Complete SECTIONS 2-3 and e-mail to: DASASRFP@bls.gov with the subject “COMPANY NAME

PAST PERFORMANCE QUESTIONNAIRE”.

(DO NOT PROVIDE COPY BACK TO THE OFFEROR)

SECTION I: (To be filled out by the Offeror)

Contract Name/Program Name

Contract/BPA/Task Order Number(s)

Type of Contract

Contract Period of Performance

Contract Duration

Contract/Task Order Amounts

Name/Contact Information of Customer

Point of Contact for Offeror Information (Telephone, Fax, Email Address, Mail Address)

Other Relevant Information

SECTION II: (To be filled out by the client reference completing the questionnaire) The information provided in this section by the client references shall be of past performance that is relevant for contracts and/or sub-contracts in any amount and shall be on project work same or similar in nature as that provided in the performance work statement.

Name of Company/Federal, State, or Local Agency completing the Questionnaire

Name of person completing the Questionnaire

Agency/Company/Organization

Your role with respect to the Contractor (e.g. Contracting Officer, Program Manager, Consumer, etc.)

Length in role (years and months)

Email Address

Telephone Number (include area code)

Fax Number (include area code) mailto:DASASRFP@bls.gov

Other Relevant Information

Information Accuracy:

Is the information provided by the Offeror in Section I accurate, to the best of your knowledge?

[ ] YES [ ] NO

SECTION III: (To be filled out by the client reference completing the questionnaire) The information provided in this section by the client references shall be of past performance that is relevant for contracts and/or sub-contracts in any amount and shall be on project work same or similar in nature as that provided in the performance work statement.

Please use the following rating scale to rate the Contractor:

RATING EXPLANATION

Outstanding

Performance meets contractual requirements and exceeds many to the client’s benefit.

The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Good

Performance meets contractual requirements and exceeds some to the client’s benefit.

The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

Acceptable 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 appear or were satisfactory.

Marginal

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unacceptable

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.

Not applicable Not applicable to the contract.

For each segment, please include narrative with specific, relevant examples where at all possible. Additional comments may be attached, as necessary.

A. Prime Contractor’s Management Practices

1. Please rate the Contractor’s Management structure in terms of responsiveness, efficiency and how well it met the needs of your company or agency.

RATING Please check one.

Outstanding

Good

Acceptable

Marginal

Unacceptable

Not applicable

COMMENTS:

2. How effective and thorough was the Contractor in reporting on the status of their current projects. How valuable was this reporting to your agency’s objectives and planning activities?

Good

Acceptable

Marginal

3. How effective and professional was the Contractor in working and communicating with agency or customer personnel?

Good

Acceptable

Marginal

B. Prime Contractor’s Performance

1. How well was the Contract staffed to be able to fill requests appropriately?

Good

Acceptable

Marginal

2. What was the level of skill and competency of the staff provided by the Contractor?

Good

Acceptable

Marginal

3. How well did the Contractor provide quality control?

Good

Acceptable

Marginal

4. How well did the Contractor transition into the current contract?

Good

Acceptable

Marginal

C. Prime Contractor’s Delivery Schedules

1. Please rate the Contractor’s ability to meet recurring deadlines for multiple deliverables on time.

Good

Acceptable

Marginal

2. Please rate the Contractor’s ability to meet the requirements of the Contract at the agreed upon pricing.

Good

Acceptable

Marginal

D. Summary

1. Were there any instances in which the Contractor received additional consideration for superior performance?

[ ] YES [ ] NO [ ] NOT APPLICABLE

2. Were there any instances in which the Contractor was required to provide explanations due to poor performance or the non-availability of the system/services/staff resources?

[ ] YES [ ] NO [ ] NOT APPLICABLE

Please rate the overall performance of the Contractor:

Good

Acceptable

Marginal

E. Additional Comments

Please provide any additional comments regarding this Contractor’s past performance, as desired, either below or as an attachment:

*By signing this Questionnaire, I verify that the information contained in this reference is accurate, to the best of my knowledge.*

PRINTED NAME

TITLE

AGENCY/ORGANIZATION/ROLE

Signature