Attachment_J-7_Past_Performance_Confirmation_Questionnaire.docx

SOLICITATION NUMBER: DOL-ETA-16-R-00023 Operation of the Roswell Job Corps Center

ATTACHMENT J-7

Past Performance Questionnaire

To Whom it May Concern:

The _______________ Company is currently responding to the U. S. Department of Labor RFP #DOL_____________ for the procurement of the continued operation of the ________Job Corps Center.

The U. S. Department of Labor is placing increased emphasis in their procurements on past performance as a source selection factor. They are requiring that clients of entities responding to their solicitations be identified and their participation in the evaluation process be requested. Therefore, we are requesting that you provide the following information regarding our performance on the contract identified below. Please complete Sections B-F of this Questionnaire and return it directly to the address shown below no later than ________ a.m./p.m., ______________, 2012.

ATTN: __________________

Office of Contracts Management (OCM)

U.S. DOL – ETA

E-mail__________________________

By my signature below, I authorize you to respond to any additional inquiries by the U. S. Department of Labor regarding our performance on the referenced contract.

(Signature) (Date)

(Title)

A. Past Performance

A. Contract Identifying Information:

Offeror:

Project Title & Contract Number:

Contracting Officer:

Phone No.

Address:

FAX No.

Work Performance Period: _____________________ to ______________________

Contract Value: $

Brief Summary of Statement of Work:

B. Outcomes vs. Goals:

1. Were there measurable performance goals or outcomes associated with this contract? If yes, describe:

Yes No

For the following questions, where applicable, check the adjectival rating which most closely represents your assessment of the contractor's performance: Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory

Very Good Satisfactory Marginal Unsatisfactory

C. Cost Control: How well has the contractor:

Very Good Satisfactory

Very Good Satisfactory

3. Has a draft or final audit report disclosed questioned or disallowed costs? If yes, indicate:

period covered by audit disallowed or recommended for disallowance disallowed costs as a % of audited funds Yes No

Comments: (Explain any ratings below Satisfactory)

Summary Adjectival Rating of Cost Control Exceptional Very Good Satisfactory

D. Timeliness of Performance: How well has the contractor:

Satisfactory

Satisfactory

Comments: (Explain any ratings below Satisfactory)

Satisfactory

E. Business Relations: To what extent has the contractor:

Satisfactory

Satisfactory

Satisfactory

Comments: (Explain any ratings below Satisfactory)

Summary Adjectival Rating of Business Relations

F. Customer Satisfaction: To what extent has the contractor:

1. Been effective in tailoring the program to meet the needs of the customers?

Exceptional Very Good Satisfactory Marginal Unsatisfactory

2. Shown flexibility in operating the program to meet changing program needs and emphases?

Exceptional Very Good Satisfactory Marginal

Comments: (Explain any ratings below Satisfactory)

Summary Adjectival Rating of Customer Satisfaction

Exceptional Very Good Satisfactory Marginal

Additional Comments:

Name & Title of Individual Completing Information:

Phone No.

(For Department of Labor Use Only)

SUMMARY PAST EXPERIENCE CONFIRMATION

B. Outcomes vs. Goals

C. Cost Control

D. Timeliness of Performance

E. Business Relations

F. Customer Satisfaction

Verified by:___________________________________________Date:____________________