Attachment J-17 Past Performance Questionnaire.docx

Attachment J-17 Past Performance Questionnaire When filled in, this document is Source Selection Sensitive Information IAW FAR 2.101 and 3.104.

1. The Court Services and Offender Supervision Agency (CSOSA) is conducting an acquisition to provide the following: Residential Housing Services.

2. You have been listed by (enter name of entity submitting a quote) as a current or past client reference who can serve as a past performance reference. The following information is being collected to help the CSOSA Contracting officer evaluate past performance during the evaluation of proposals.

3. The survey should be completed by the individual most knowledgeable of the Contractor’s day-to-day operations and overall condition of services being rendered. That individual is encouraged to supplement their own knowledge of the Contractor’s performance with the judgment of others in their organization, as applicable.

4. Handwritten responses are sufficient. Please make them 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 survey. If more space is needed, additional pages may be added.

6. As the survey relates to an ongoing source selection for the services for above identified requirement, we request that all information provided within the survey be safeguarded against unauthorized disclosure.

7. Upon completion of the questionnaire, please e-mail it to Matthew Collins at matthew.collins@csosa.gov no later than August 17, 2026 at 5:00 PM Eastern Time.

Date of Survey: ________________________________________________________________ Name of Person Completing Survey:________________________________________________ Title of the Person Completing Survey:______________________________________________ Telephone and Fax Number:_______________________________________________________ Email Address:_________________________________________________________________ Your Company/Agency:__________________________________________________________ Contract Name:_________________________________________________________________ Contract Number: _______________________________________________________________ Period of Contract Performance: ___________________________________________________ Total Dollar Amount of Contract: __________________________________________________ Your Role in this Contract: _______________________________________________________ General description of products/services required under the contract: _______________________

6. Did the contractor perform as a prime or subcontractor? _______________________________

7. Performance Information. Choose the number on the scale of 1 to 6 that most accurately describes the contractor’s performance or situation. Please provide a narrative explanation for any ratings of 1, 2 or 3.

Evaluation Ratings

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.

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

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 were satisfactory.

Performance meets contractual requirements with some exceeding to the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

Performance meets contractual requirements with many exceeding the Government’s benefit. The contractual performance of the element or sub- element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Place an “X” in the appropriate block using the definitions matrix above.

SCHEDULE

MANAGEMENT OF KEY PERSONNEL

Solicitation Number: 9594CS25Q0066 Attachment J-13 Past Performance Questionnaire

QUALITY OF SERVICES

Remarks Section.

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BUSINESS RELATIONS

Sect ion.

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