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9594CS26Q0003 - Attachment J-14 Past Performance Questionnaire 9594CS26Q0003 – Attachment J-14: Past Performance Questionnaire
PLEASE EMAIL THE COMPLETED QUESTIONNAIRE NO LATER THAN 8:00 PM (local Washington, DC time), March 6, 2026 TO: catherine.collins@csosa.gov .
1. The Contractor in A below has identified the Questionnaire Respondent as someone for whom the Contractor provided a service similar to the service requirement in paragraph 2.
2. The Contractor is submitting a proposal to the Court Service and Offender Supervision Agency (CSOSA) to provide the following: Outpatient Treatment Services.
3. This Questionnaire should be completed by the individual most knowledgeable of the Contractor’s day-to-day operations and overall condition of the supplies/services provided under the referenced contract. However, that individual is encouraged to supplement their knowledge of the Contractor’s performance with the judgement and observations of others within their organization, as applicable.
4. Handwritten responses are sufficient, however, please ensure they are legible.
5. Please provide explanatory narratives for as many responses as possible. These narratives need not be lengthy, just descriptive. Space for narrative comments is included on the last page of the questionnaire. If more space is required, additional pages may be added to this questionnaire. Please clearly identify which evaluation factor a narrative applies to.
6. As this questionnaire relates to an ongoing source selection for “Outpatient Treatment Services”, we request that all information provided in this questionnaire be safeguarded against unauthorized disclosure.
A. CONTRACTOR/PROJECT INFORMATION: (Contractor requesting reference complete Section A)
Contractor Name:
Reference Contract Number:
Project Title or Brief Description of the Supplies/Services Provided by the Contractor under the Reference Contract:
Note: If the Contractor holds, or has held, other contracts with your agency/organization in the last 5 years, if possible, please complete a separate questionnaire for each of those contracts.
B. QUESTIONNAIRE RESPONDENT INFORMATION:
Respondent Name: Title:
Respondent’s Phone #: Email:
Respondent’s Company Name:
Company Address:
CONTRACT PERFORMANCE INFORMATION:
1. What was the period of performance start and end dates for the Reference Contract:
From: To:
2. What was the total value of the Reference Contract?
3. In what capacity did the Contractor provide supplies/services to under the Reference
Contract? Prime Contractor ______ Subcontractor ______ Key Person ________
4. Please use the following Performance Scale to rate the Contractor’s performance on the Reference Contract, where a 6 is Exceptional and a 1 is Neutral. Please place the number that corresponds with the level of performance that you experienced/observed in the box on the right side of the performance criteria.
5. Please provide a narrative explanation for any ratings of 1, 2 or 3.
Performance Scale
| 1 |
| Contractor’s responsiveness/timeliness in providing the required services. |
| 2 |
| Contractor’s responsiveness/timeliness to administrative functions of the contract. |
| 3 |
| Contractor’s responsiveness/timeliness in responding to questions or correspondence. |
| 4 |
| Contractor’s compliance with contract terms and conditions. |
| 5 |
| Were any contract concessions, changes, or terminations made due to the contractor’s failure to accurately plan? |
| MANAGEMENT OF KEY PERSONNEL |
| RATING |
| 6 |
| Demonstrated the ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period? |
| 7 |
| Contractor's preparation & training of personnel |
| 8 |
| Contractor's ability to effectively manage subordinates. |
| QUALITY OF SERVICES |
| RATING |
| 9 |
| Provided effective quality control and/or inspection procedures to meet contract requirements. |
| 10 |
| Followed the approved quality control plan. |
| 11 |
| Corrected deficiencies in a timely manner and pursuant to the quality control procedures. |
| 12 |
| Provided timely resolution of contract discrepancies. |
| 13 |
| Suggested alternative approaches to problem solution. |
| 14 |
| Displayed initiative to identify and solve problems as they occurred. |
| 15 |
| Developed realistic progress schedules. |
| 16 |
| Met established project schedules. |
| 17 |
| Demonstrated ability to assimilate & accommodate changes in contractual requirements and/or priorities. |
| 18 |
| Exhibited knowledge of, and compliance with, Government (or other) rules and regulations. |
| 19 |
| Demonstration of technical expertise in providing all contracted services. |
| 20 |
| Possessed and utilized the tools and equipment necessary to adequately provide the required services. |
| 21 |
| Accomplishment in meeting the quality standards specified for: |
a. Technical Performance
b. Administrative Performance
c. Safety & Health
| 22 |
| Did the Contractor ever fail to effectively control the quality of services provided? If Yes, please explain in the Narrative Remarks section below. |
| 23 |
| Was a Contract Discrepancy Report, or equivalent, ever issued? If Yes, please explain in the Narrative Remarks section below. |
| 24 |
| Was a Cure Notice or Show Cause Letter ever issued? If Yes, please explain in the Narrative Remarks section below. |
| 25 |
| Were there any disputes/claims relative to the contract? If Yes, please explain in the Narrative Remarks section below. |
| 26 |
| Has Contractor demonstrated the ability to correct any of the problems identified in 22, 23, 24 or 25 above? If Yes, please explain in the Narrative Remarks section below. |
| 27 |
| Has this Contractor ever been terminated for default? If Yes, please explain in the Narrative Remarks section below. |
| 28 |
| Has an election ever been made to not exercise an option due to the Contractor's poor performance? If Yes, please explain in the Narrative Remarks section below. |
| BUSINESS RELATIONS |
| RATING |
| 29 |
| Contractor's management of subcontractors. |
| 30 |
| Have there been any labor disputes? If Yes, please explain in the Narrative Remarks section below. |
| 31 |
| Have there been any violations of Public Law, especially the Service Contract Act? If Yes, please explain in the Narrative Remarks section below. |
| 32 |
| Contractor's ability/willingness to consistently provide prompt and courteous service. |
| 33 |
| Contractor's ability/willingness to promptly and courteously resolve customer complaints. |
| 34 |
| Contractor's overall commitment to customer satisfaction. |
| 35 |
| Contractor's overall cooperation relative to the contract. |
| 36 |
| How would you rate the integration and coordination of all activity needed to perform this contract? |
| 37 |
| How would you rate the Contractor's overall performance? |
| 38 |
| Would you award another contract to this Contractor? If Not, please explain in the Narrative Remarks section below. |
Narrative Remarks: (Please include the corresponding question # in the remark):
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