G.004_Past Performance Reference Questionnaire.pdf

Attachment G.004 Page 1 of 5

When filled in this document is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104

PAST PERFORMANCE REFERENCE QUESTIONNAIRE

<This section is to be completed by the offeror and provided to the reference with instructions to submit the completed questionnaire directly to the government Point of Contact identified in section IV.>

Contractor:

Contract Number:

Contract Name:

Rater Name:

Rater Telephone:

Rater E-Mail Address:

Rater’s Role in Relation to the Contract (program/project manager, contracting officer, major end user, etc.):

Rating Definitions

Rating Definition Note

Exceptional (E)

Performance met contractual requirements and exceeded many to the government’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.

To justify an “exceptional” rating, identify multiple significant events and state how they were of benefit to the government. A singular benefit, however, could be of such magnitude that it alone merits an “exceptional” rating. Also, there should have been no significant weaknesses identified.

Very Good

(VG)

Performance met contractual requirements and exceeded some to the government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems

To justify a “very good” rating, identify a significant event and state how it was a benefit to the government.

There should have been no significant weaknesses identified.

Attachment G.004 Page 2 of 5 for which corrective actions taken by the contractor were effective.

Satisfactory (S)

Performance met contractual requirements. The contractual performance of the element or sub-element contained some minor problems for which corrective actions taken by the contractor appeared to be or were satisfactory.

To justify a “satisfactory” rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract/order.

There should have been no significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be evaluated with a rating lower than “satisfactory” solely for not performing beyond the requirements of the contract/order.

Marginal (M)

Performance did not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflected a serious problem for which the contractor did not identify corrective actions. The contractor’s proposed actions were only marginally effective or were not fully implemented.

To justify a “marginal” performance rating, identify a significant event in each category that the contractor had trouble overcoming and state how it affected the government. A “marginal” rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter).

Unsatisfactory (U)

Performance did not meet most contractual requirements and recovery was not accomplished in a timely manner.

The contractual performance of the element or sub-element contained a serious problem(s) for which the contractor’s corrective actions were ineffective.

To justify an “unsatisfactory” rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it affected the government. A singular problem, however, could be of such serious magnitude that it alone merits an “unsatisfactory” rating. An “unsatisfactory” rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g., management, quality, safety, or environmental deficiency report or letter.

INDEX

Section I – Ratings Section II – Additional Narrative Justification Section III – Signature of Rater Section IV – Return Instructions and Contact Information

Attachment G.004 Page 3 of 5

Please provide any relevant information to support the above ratings.

<Note: When completing this questionnaire by e-mail, please do not use a color, such as red, to select the rating in section I of this questionnaire.

Color fonts do not show well when printed. Please bold it, underline it, or increase the font size in black.>

Section I - Contractor Performance

1. How would you rate the quality of the contractor’s conformance to contract requirements? Supporting narrative: <see above criteria>

Response

E VG S M U N/A

2. How would you rate the quality of Contractor’s personnel provided under the contract and level of customer service? Supporting narrative: <see above criteria>

E VG S M U N/A

3. How would you rate the contractor’s ability to meet special needs (such as emergency recruitment and/or replacement of required contract personnel? Supporting narrative: <see above criteria>

E VG S M U N/A

4. How would you rate the contractor’s ability to effectively manage, coordinate, and integrate subcontractors? Supporting narrative: <see above criteria>

E VG S M U N/A

Attachment G.004 Page 4 of 5

5. How would you rate the quality of the contractor’s management of Resources and Personnel?

Supporting narrative: <see above criteria>

E VG S M U N/A

6. How would you rate the performance of the contractor’s management team in the completion of the contract, as a whole? Supporting narrative: <see above criteria>

E VG S M U N/A

7. How would you rate the Contractor’s ability to address and account for personnel problems?

Supporting narrative: <see above criteria>

E VG S M U N/A

8. How would you rate your overall satisfaction with the contractor’s compliance with laws & regulations?

Supporting narrative: <see above criteria>

E VG S M U N/A

Attachment G.004 Page 5 of 5

9. How would you rate your overall satisfaction with the contractor’s compliance with laws & regulations?

Supporting narrative: <see above criteria>

E VG S M U N/A

10. How would you rate your overall satisfaction with the contractor’s performance? Supporting narrative: <see above criteria>

E VG S M U N/A

Section II - Additional Supporting Narrative, if required: <Include the number of the question to which this supporting narrative applies.

Additional pages may be used.>

Section III

Signature of rater: _______________________________________

Date: __________________________________________________

<Signature of rater is required, if faxed. It is not required if sent via e-mail directly from rater.>

Section IV Please return the completed questionnaire via e-mail to WFL.Purchasing@dot.gov or by fax to 360-619-7855.

Please include “RFQ 69056721Q000009 Past Performance Review” in the subject line.

Please return the completed questionnaire no later than Monday, January 25, 2020 at 4:00pm Pacific Time.