Past-Performance_form-Attestation Engagements ATT3.pdf

PAST PERFORMANCE EVALUATION FORM Rev. 8/11/2009

FOR

Solicitation #:

Company (Offeror) Name:

ATTACHMENT 3 Page 1 of 4

SOURCE SELECTION INFORMATION/CONFIDENTIAL

AGENCY/COMPANY PROVIDING EVALUATION: ________________________________

CONTRACT NUMBER: _______________________________________________________________

(Current or Previous – State Period of Performance Dates)

SUMMARY: THE OFFEROR IS TO SUBMIT THIS FORM TO A PREVIOSUS

CUSTTOMER /CLIENT TO COMPLETE AND SUBMIT AS SPECIFIED IN THE

INSTRUCTIONS TO THE CONTRACTING OFFICER

The purpose of this form is for the Company (Offeror) identified above to obtain a performance evaluation from a present or past customer/client. Responses will be used as an evaluation element in the source selection process for the above Solicitation Number. The information described in this form refers to the type of product or service the Company/Offeror will be required to provide under the solicitation, if selected. The statement of work under the solicitation is for the contractor to provide attestation engagement services to the United States Department of Labor, Bureau of International Labor Affairs, Office of Child Labor, Forced Labor and Human Trafficking.

Please return completed form to: William M. Stevens Contracting Officer US Department of Labor OASAM Office of Procurement Services

RM S4307

200 Constitution Ave., NW Washington DC 20210 stevens.william@dol.gov 2002-693-482

EVALUATION PROVIDED BY: (Name, Title, and Organization Address)

(Name & Title) Organization Address

Telephone Fax

RATINGS GUIDE

Using this rating guideline, assign each area a rating of

1 Unsatisfactory 2 Marginal 3 Average 4 Above Average 5 Outstanding N/A Not Applicable

Solicitation #:

Company (Offeror) Name:

ATTACHMENT 3 Page 2 of 4

SOURCE SELECTION INFORMATION/CONFIDENTIAL

The elements are quality of product, cost control, timeliness of performance/delivery schedule, and overall customer satisfaction. In the remark section(s) for Outstanding or Unsatisfactory performance, provide a brief narrative to support the ratings assigned.

For each performance element, please check the appropriate column

U ns at is fa ct or y

M ar gi na l

A ve ra ge

A bo ve A ve ra ge

O ut st an di ng

N ot

A pp lic ab le

Performance Elements 1 2 3 4 5 N/A

QUALITY OF PRODUCT OR SERVICE

1. How would you rate the Contractor’s demonstrated ability to solve contract performance problems without extensive guidance from government counterparts?

2. How would you rate the Contractor’s demonstrated ability to internally manage your task order(s)?

3. How would your rate the Contractor’s demonstrated ability to conform to the terms and conditions of your contract?

4. How would you rate the Contractor’s demonstrated ability to ensure deliverables are met or exceed specified standards for acceptance?

5. How would you rate the Contractor’s demonstrated ability to perform concurrent tasks and perform for multiple projects?

6. How would you rate the Contractor’s demonstrated ability to adhere to contract hours of performance, sustained-employee performance levels, and quality assurance of deliverables?

7. How would you rate the Contractor’s demonstrated ability to respond to/follow-up on problem identification, problem tracking, documentation and reporting accurately and timely?

TECHNICAL PERFORMANCE

8. How would you rate the Contractor’s ability to perform to any required technical standards identified in the Statement of Work?

9. How would you rate the Contractor’s ability to collaborate with end-users, technical staff, and management, to efficiently deliver services?

10. How would you rate the Contractor’s ability to train and retain highly skilled staff and maintain low turnover?

CONTRACT MANAGEMENT

11. Rate the contractor’s demonstrated ability to adhere to contract delivery schedules.

Solicitation #:

Company (Offeror) Name:

ATTACHMENT 3 Page 3 of 4

SOURCE SELECTION INFORMATION/CONFIDENTIAL

For each performance element, please check the appropriate column

U ns at is fa ct or y

M ar gi na l

A ve ra ge

A bo ve A ve ra ge

O ut st an di ng

N ot

A pp lic ab le

Performance Elements 1 2 3 4 5 N/A

COST MANAGEMENT

12. Rate the Contractor’s ability to control cost, and administrative procedures utilized to manage personnel resources, subcontractor costs and other direct/indirect costs.

TOTAL SCORE =

Solicitation #:

Company (Offeror) Name:

ATTACHMENT 3 Page 4 of 4

SOURCE SELECTION INFORMATION/CONFIDENTIAL

CONTRACT DESCRIPTON:

1. Size of the contract (dollars)?

2. Term of the contract (months)?

3. Number of tasks?

4. Number of deliverables?

REMARKS ON OUSTANDING PERFORMANCE:

REMARKS ON UNSATISFACTORY PERFORMANCE

WOULD YOU HIRE THIS COMPANY AGAIN? Yes No

OTHER COMMENTS

Note: If verbal telephonic response was obtained, complete the following

Information obtained by

Signature

Date & Time