Attachment 3- Past Performance Eval Form.doc

Yocum Fuel Dispensing System Architecture and Engineering Design

RFQ #: 693JF722Q000005

Attachment 3 – Past Performance Evaluation Form

Name of Evaluator:

Organization:

Official Position:

Phone/Email:

Name of Company Evaluated:

Company Address:

Contract No. (Indicate if prime/subcontractor):

Contract Period of Performance:

_____/_____/______ to ____/____/_____

Contract Type:

Contract Value:

PLEASE RETURN THIS SURVEY VIA E-MAIL TO: Juebiline.Mbandi@dot.gov and emmanuel.riddle.ctr@dot.gov by February 28, 2022 at 2:00 PM Eastern Time (ET) with the subject line: “Past Performance Evaluation for (insert Vendor)- 693JF722Q000005.

Please provide a thorough and complete description of the most recent services you have contracted for from the vendor.

INSTRUCTIONS – For each item, circle the rating that best describes the contractor’s work on this project and provide any additional comments. For items not applicable to your project, please indicate N/A.

5= Exceptional

No problems, issues, or delays in achieving contract requirements

4= Good

Does not impact achievement of contract requirements

3=Acceptable

Requires minor agency resources to ensure achievement of contract requirements

2=Marginal

Requires major agency resources to ensure achievement of contract requirements

1= Unacceptable

Achievement of contract requirement is compromised

N/A= Not applicable Does not apply

(1) Overall Quality of Contract Performance

N/A Comments: __________________________________________________________________________________________________________________________________________________________________________________________________________

(2) Contractor’s ability to meet deadlines, be responsive to

N/A

Inquiries, and provide deliverables as scheduled Comments: __________________________________________________________________________________________________________________________________________________________________________________________________________

(3) Contractor’s ability to effectively forecast, manage

N/A and control costs (Not applicable for Fixed-Price contracts/orders) Comments: __________________________________________________________________________________________________________________________________________________________________________________________________________

(4) Timeliness, completeness and quality of problem identification, N/A corrective action plans, reasonable and cooperative behavior, customer satisfaction, and management of sub contract personnel Comments: __________________________________________________________________________________________________________________________________________________________________________________________________________

Based on this contractor’s overall performance, would you award this contractor a similar contract?

Yes [ ] No [ ] If “no’, please explain:

Has this contract been partially or completely terminated?

Yes [ ] No [ ] If “yes’, please explain:

Were there any changes in contract dollar value throughout the life of the contract?

Yes [ ] No [ ] If “yes”, please explain:

In summary, please give your overall assessment of this contractor and the actual results achieved as a result of this contractor’s performance.

PAGE