ATTCH 1 Performance_Questionnaire.pdf

Solicitation Nr: ______________ Attachment _ – Past and Present Performance

Information/Questionnaire

ATTACHMENT ___

PAST AND PRESENT PERFORMANCE INFORMATION/QUESTIONNAIRE

PART I: REFERENCE INFORMATION (Offeror to complete this part and return with Past

Performance information in accordance with instructions in 52.212-1 volume)

A. Offeror Information

Contractor’s Name: _______________________________________ Telephone Number: _______________________________________ Address: _______________________________________ Fax Number: _______________________________________ Point of Contact: _______________________________________

B. Project Title (Note to Offeror: Attach a description of services to completed form (IAW 52.212-1)

C. Contract Data Contract Number: _________________________ Delivery/Task Order Nr: ___________________

Point of Contact Name: ___________________ Title: ___________________ Phone Number: _________________ Email: __________________________ Contract Type: ________________________ Contract Dollar Value: (Base Year $____________________) ($_____________________, including all options) Contract Period/ Dates of Performance: ____________________ (base + all option periods) Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

PART II: RESPONDENT INFORMATION (To be completed by Reference Point of Contact)

A. Reference/Respondent Information

Name of Respondent: ____________________________Contract Number: _________________________ Title: ___________________________________________Total Contract Value: $_____________________ Organization Name: _______________________________Period of Performance _____________________ Telephone Number: _______________________________ Fax Number: _____________________________________ Email Address: ___________________________________

Please identify any information known to be inaccurate as provided by the Offeror in Part I.

B. Email completed questionnaire form to: Lin.Na@dol.gov

Information/Questionnaire

C. PERFORMANCE INFORMATION: Using the adjectival rating table below, choose the appropriate letter in the attached Questionnaire (i.e., E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation.

ADJECTIVAL RATING DEFINITION

E Exceptional

Performance meets contractual requirements with many exceeded to 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.

G Good

Performance meets contractual requirements with some exceeded 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.

S 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.

M Marginal

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

U Unsatisfactory

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

N Neutral Performance was not observed or not applicable to the current effort being reported against

Information/Questionnaire

CURRENT/PAST PERFORMANCE QUESTIONNAIRE

Contractor’s Name:_____________________ Contract Number: _________________

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

The Contractor: E G S M U N

1. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2. Provided adequate project supervision.

3. Demonstrated ability to hire, retain, and replace, if necessary, qualified personnel during the contract period.

4. Followed approved quality control plan.

5. Corrected deficiencies in timely manner and pursuant to their quality control procedures.

6. Provided timely resolution of contract discrepancies.

7. Identified problems as they occurred.

8. Suggested alternative approaches to problems.

9. Displayed initiative to solve problems.

10. Developed realistic progress schedules.

11. Met established project schedules.

12. Was responsive to contract changes.

13. Provided accurate and complete line item cost proposals including all aspects of work required for each task.

14. Cooperated with Government personnel after award.

15. How would you rate the contractor's overall performance?

16. Was the contractor ever issued a cure or show cause notice under the referenced contract?

If yes, explain outcome in “remarks.”

YES

NO

17. Would you award another contract to this contractor? If not, explain in “remarks.” YES

NO

18. Is the contractor rated in CPARS? YES

NO

Comments: Please provide additional information for any area rated above.