RFP DOL089RP20612 - ATTACHMENT D.2 - PAST PERFORMANCE QUESTIONNAIRE.doc

PAST PERFORMANCE QUESTIONNAIRE

RFP DOL089RP20612

US DEPARTMENT OF LABOR

OSHA DATA INITIATIVE

Section I: The offeror submitting the response to the RFP shall complete Section I of this document.

Section II and III: The offeror shall submit this document to the offeror’s client references for completion of Sections II and III. The offeror shall obtain three (3) client references for this past performance questionnaire for work performed within the last three (3) years, which is the same or similar to the requirements of this solicitation in terms of size and magnitude. The offeror’s client shall submit all completed past performance questionnaire documents to: Ronald J. Jordan., Office of Procurement Services, US Department of Labor, 200 Constitution Ave, NW, Room S-4304, Washington, DC 20210-0001 or via e-mail to jordan.ronald@dol.gov, or by fax to

(202) 693-4579, and shall be signed by the client references.

SECTION I:

The term “contract” below means contract, Blanket Purchase Agreement (BPA), task/delivery order, purchase order, or other contract vehicle.

a. Contract name/Program name

b. Contract Number(s)

c. Type of contract(s)

d. Contract Period of Performance

e. Contract Duration (period contractor performed work)

f. Contract/Task Order Amounts

g. Name, Telephone/Fax Number, and E-mail address of Customer Point of Contact for offeror Information

h. Other relevant information

Description of project and services provided __________________________________________________________________________________________________________________________________________________________________

SECTION II & III TO BE COMPLETED BY THE OFFEROR’S CLIENT REFERENCE, ONLY

The information provided in this section by the client references shall be of past performance that are relevant for contracts and/or sub-contracts and shall be on project work same or similar in nature. So, please be specific.

SECTION II

a. Name of Company/Federal, State or Local Agency completing this section of the questionnaire

b. Name of person completing this of the questionnaire

c. Agency/Organization

c. Your role with respect to the Contractor (e.g. Contracting Officer, Program Manager)

d. Length in role (years and months)

e. E-mail address

f. Telephone number with area code

g. Fax number with area code

i. Date questionnaire completed

j. Other relevant information

Information Accuracy:

Is the information provided by the Offeror in Section I accurate?

[ ] YES [ ] NO

If NO, please provide an explanation or description (Be specific.):

SECTION III

For each of the following questions, provide a rating of:

(a) Exceptional--surpasses the minimum performance level of the contract.

(b) Satisfactory--meets the performance level of the contract.

(c) Marginal--often does not meet the performance level of the contract.

(d) Unsatisfactory—did not meet the performance level of the contract.

(e) Not applicable.

For each response, please include some narrative with appropriate specific examples.

A. Prime Contractor’s Management Practices

1. Please rate the Contractor’s Management structure in terms of responsiveness, efficiency and how well it met your company/agency needs?

(a) Exceptional (b) Satisfactory

(c) Marginal (d) Unsatisfactory

(e) Not Applicable

Comments______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. How effective and thorough was the Contractor in reporting on the Contract’s performance?

(a) Exceptional (b) Satisfactory

(c) Marginal (d) Unsatisfactory

(e) Not Applicable

Comments____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. How effective and professional was the Contractor in working and communicating with agency/customer personnel?

(a) Exceptional (b) Satisfactory

(c) Marginal (d) Unsatisfactory

(e) Not Applicable

Comment____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

B. Prime Contractor’s Performance

1. How valuable and instrumental were the Contractor’s performance reports to your agency’s goals and objectives and planning activities?

(a) Exceptional (b) Satisfactory

(c) Marginal (d) Unsatisfactory

(e) Not Applicable

Comment______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. How well was the Contract staffed for meeting your agency’s performance objectives?

(a) Exceptional (b) Satisfactory

(c) Marginal (d) Unsatisfactory

(e) Not Applicable

Comment____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C. Prime Contractor’s Delivery Schedules

1. Please rate the Contractor’s performance in terms of delivering required services on time and on budget?

(a) Exceptional (b) Satisfactory

(c) Marginal (d) Unsatisfactory

(e) Not Applicable

Comment____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D. Summary

1. Please rate the overall performance of the Contractor.

(a) Exceptional (b) Satisfactory

(c) Marginal (d) Unsatisfactory

(e) Not Applicable

Comment____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Were there any instances in which the Contractor received additional consideration for superior performance?

(a) Yes _____ (b) No ______ (c) Not Applicable ______

Comment________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Were there any instances in which the Contractor was required to provide explanations due to poor performance or the non-availability of the system/services/staff resources?

(a) Yes _____ (b) No ______ (c) Not Applicable ______

Comment______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Print Name/Federal Agency Client Reference/Representative Point of Contact & Phone Number Completing this Document

Signature of Reference/Representative