Attachment L-2 Past Performance Questionnaire.doc

L-2 PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE

IAW FAR 2.101 AND 3.104

SOLICITATION: RFP: 12SAD120R0012

RURAL WATER CIRCUIT RIDER AND TECHNICAL ASSISTANCE PROGRAM

CONTRACTOR: __________________________

I. Background

The U.S. Department of Agriculture (USDA), Rural Development (RD) is currently in the process of soliciting for a competitive service contract for its program FORMDROPDOWN entitled, Rural Walter Circuit Rider Technical Assistance Program. The purpose of this program is to protect the nation’s multi-billion-dollar investment in rural and small municipal waters systems by providing on-site technical assistance that assures cost-effective operations and adequate income for both operations and debt service within each state/jurisdiction. The Contractor is required to operate rural water circuit technical assistance program providing assistance to eligible systems in all 50 States, and the U.S. Territories.

This questionnaire is to obtain past performance information relative to contracts that have previously been completed within the past three years or are currently being performed by the contractor identified above. This company is a potential source for performing a five-year Firm Fixed Priced contract

II. Instructions

Please complete the questionnaire based on the following guidance:

A. Handwritten responses are sufficient.

B. Indicate, based on the description below, the contractor’s performance on the identified program in the assessment area. Assessments should reflect only contractor liable performance. The following is a definition of the scoring levels:

NO

CONFIDENCE

Based on the offeror’s recent/relevant performance record, the government has no expectation that the offeror will be able to successfully perform the required effort.

** In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned therefore resulting in an Unknown Confidence rating, the offeror may not be evaluated favorably or unfavorably on past performance (see FAR 15.305(a)(2)(iv)).

Check next to the word corresponding to your rating

C. Please provide comments for all questions in which a “No Confidence”, “Limited Confidence”, or “Satisfactory Confidence” rating is given and as appropriate for all other answers. Space for your comments is provided in each area. If more space is needed, attach additional sheets to the end of the questionnaire and reference the respective question.

D. You are urged to supplement your own knowledge of the offeror’s performance with the judgement of others in your organization. In addition to completing the attached questionnaire for the program, we solicit your comments on other similar programs for which your office has contracts with this offeror.

E. PLEASE EMAIL YOUR COMPLETE QUESTIONNAIRE WITHIN 7 DAYS AFTER RECEIPT, BUT NO LATER THAN 1:00pmEST, Thursday, October 1, 2020, TO:

RD.ACQUISITIONS@USDA.GOV

YOUR ASSISTANCE IN EVALUATING THE CONTRACTOR’S PAST PERFORMANCE IS APPRECIATED. OUR GOAL IS TO SELECT THE BEST VALUE TO THE GOVERNMENT. YOUR PAST PERFORMANCE EVALUATION IS A CONSIDERATION IN DETERMINING THE BEST VALUE.

III. Program Identification:

Evaluator please complete:

A. Contractor:

B. Contract Number: __________________________________________

C. Estimated contract dollar amount: _____________________________

D. Period of Performance: _____________________________________

E. Describe product acquired: ___________________________________

F. Contract Type: ____________________________________________

G. Contract Description: Brief description of the services provided by the contractor for this contract.

[Type here]

IV. Past Performance Evaluation:

1. How would you rate the contractor’s overall performance on the project?

[ ] Substantial Confidence [ ] Satisfactory Confidence [ ] Limited Confidence [ ] No Confidence [ ] Unknown Confidence Comments: ___________________________________________________________________

2. How would you rate the contractor’s responsiveness and flexibility?

[ ] Substantial Confidence [ ] Satisfactory Confidence

[ ] Limited Confidence [ ] No Confidence [ ] Unknown Confidence

Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. How would you rate the contractor’s experience with the Government’s stringent standards/regulations)?

[ ] Substantial Confidence [ ] Satisfactory Confidence

[ ] Limited Confidence [ ] No Confidence [ ] Unknown Confidence

Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

THE CONTRACTOR:

4. Provided effective quality control and/or inspection procedures to meet contract requirements?

[ ] Substantial Confidence [ ] Satisfactory Confidence

[ ] Limited Confidence [ ] No Confidence [ ] Unknown Confidence

Comments: ___________________________________________________________________

5. Effectively managed subcontractors (if used)?

[ ] Substantial Confidence [ ] Satisfactory Confidence

[ ] Limited Confidence [ ] No Confidence [ ] Unknown Confidence

Comments: ___________________________________________________________________

6. Corrected deficiencies in a timely manner?

[ ] Substantial Confidence [ ] Satisfactory Confidence

[ ] Limited Confidence [ ] No Confidence [ ] Unknown Confidence

Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7. Cooperated with Government personnel?

[ ] Substantial Confidence [ ] Satisfactory Confidence

[ ] Limited Confidence [ ] No Confidence [ ] Unknown Confidence

Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. Met volume orders in a timely manner?

[ ] Substantial Confidence [ ] Satisfactory Confidence

[ ] Limited Confidence [ ] No Confidence [ ] Unknown Confidence

Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Put an X next to the most applicable answer:

Knowing what I know about this contractor.

____I would not enter into another contract with this contractor

____I might enter into another contract with this contractor

____I would enter into another contract with this contractor

V. Additional Information, if available:

Please attach any past performance database reports or other material you deem appropriate to a full understanding of the Contractor’s past performance by the evaluator. Please provide information on any adverse performance by the contractor and the corrective actions taken.

VI. Respondent Information:

The following information will assist in the analysis of the data and will be kept confidential.

A. Name of Evaluator:_____________________________________

B. Office Symbol/Location:__________________________________

C. Phone:________________________________

D. Position of Title/Grade:___________________________________

E. Length of Time on Program/Contract:________________________

F. Date Questionnaire Completed:_____________________________