Attachment 0002_Past Perf Questionnaire.docx
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- Solicitation number
- 69056726Q000021
About this file
This is a Past Performance Reference Questionnaire template designed to evaluate contractor performance on federal contracts. The form captures structured ratings across nine key performance categories, each scored on a five-point scale: Exceptional (E), Very Good (VG), Satisfactory (S), Marginal (M), and Unsatisfactory (U), with detailed definitions provided for each rating level. The questionnaire assesses technical abilities, schedule adherence, cost management, ability to meet special needs, management team quality, subcontractor coordination, small business subcontracting performance, regulatory compliance, and personnel resource management. Each rating category requires supporting narrative justification, with detailed guidance provided to ensure raters substantiate their assessments with specific events and evidence of contractor performance relative to contractual obligations.
The questionnaire is associated with RFQ 69056726Q000021, issued by the Department of Transportation Federal Highway Administration for BRAND NAME Leica iCON GNSS Equipment Packages and peripheral services. This is a Total Small Business Set-Aside acquisition using simplified procedures for commercial products and services. Completed questionnaires must be returned via email to WFL.Purchasing@dot.gov with the subject line "RFQ 69056726Q000021 Past Performance for [vendor name]" no later than Thursday, May 21, 2026, at 4:00 PM Pacific Time. The completed questionnaire is classified as Source Selection Sensitive per FAR provisions.
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Other files
| File | Type | Posted |
|---|---|---|
| Leica iCON GNSS Justification for Restricted Competition-signed.pdf | ||
| Attachment 0001_Price Schedule.xlsx | XLSX spreadsheet | |
| 69056726Q000021_RFQ.pdf |
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Text version
Attachment 0002 Page 5 of 5
PAST PERFORMANCE REFERENCE QUESTIONNAIRE
<This section is to be completed by the offeror/quoter and provided to the reference with instructions to submit the completed questionnaire directly to the government Point of Contact identified in section IV.>
Contractor to be rated:
Contract Number:
Contract Description:
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 for which corrective actions taken by the contractor were effective. |
| 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. |
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
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 technical abilities to provide the required supplies and/or services? Consider aspects of performance such as conformance to contract requirements, specifications, and standards of good workmanship (e.g., commonly accepted technical, professional, environmental, or safety and health standards).Supporting narrative: <see above criteria>
Response
E VG S M U N/A
1. How would you rate the Contractor’s timeliness and/or ability to adhere to established schedules (e.g., milestones, delivery schedules, administrative requirements, and contract completion? Supporting narrative: <see above criteria>
E VG S M U N/A
2. How would you rate the Contractor’s effectiveness in forecasting, managing, and controlling contract or order costs? (select "N/A" for fixed-price contracts) 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 (i.e., emergency requirement, replacement of required contract personnel, etc.)? Supporting narrative: <see above criteria>
E VG S M U N/A
4. How would you rate the quality and/or performance of the Contractor’s management team as it relates to related to integration and coordination of all activity under the contract or order? Consider aspects of performance such as the timeliness, completeness, and quality of problem identification; corrective action plans; proposal submittals; history of reasonable and cooperative behavior; customer satisfaction; and timely award/management of subcontracts, if any.? Supporting narrative: <see above criteria>
E VG S M U N/A
5. How would you rate the Contractor’s ability to effectively manage, coordinate, and integrate subcontractors, if any? Supporting narrative: <see above criteria>
E VG S M U N/A
6. How would you rate the Contractor’s ability to award subcontracts to Small Businesses, Small Disadvantaged Businesses (which also includes Alaska Native Corporations and Indian Tribes), Women Owned Small Businesses, HUBZone, Veteran Owned Small Businesses, and Service-Disabled Veteran Owned Small Business, if any? Supporting narrative: <see above criteria>
E VG S M U N/A
7. How would you the contractor’s compliance with applicable laws, regulations, and contract requirements? Consider aspects of performance such as compliance with financial, environmental, safety, and labor regulations as well as any other reporting requirements in the contract terms and conditions. Supporting narrative: <see above criteria>
E VG S M U N/A
8. How would you rate the Contractor’s management of Resources and Personnel? Supporting narrative: <see above criteria>
E VG S M U N/A
9. Would you recommend the Contractor for similar requirements in the future? 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 – Rater
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 – Instructions
Please return the completed questionnaire via e-mail to WFL.Purchasing@dot.gov.
Please include “RFQ 69056726Q000021 Past Performance for < insert vendor name >” in the subject line.
Please return the completed questionnaire no later than Thursday, 21-May-2026, at 4:00pm Pacific Time.
When filled in this document is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104
File details come from the government source that posted it. Updated .