J-7_Past_Performance_Questionnaire.pdf

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.

Project Manager: 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:

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

2. How effective was the contractor in achieving those outcomes? (Explain any rating below Satisfactory) d

C. Cost Control: How well has the contractor:

1. Performed all contracted services within the budget?

2. Submitted complete and accurate financial reports and invoices?

Very Good

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

Comments: (Explain any ratings below Satisfactory)

Summary Adjectival

Rating of Cost Control

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

1. Completed contract requirements and submitted reports and schedules according to specified time frames?

2. Responded to technical direction and requests in a timely manner?

Comments: (Explain any ratings below

Satisfactory)

Summary Adjectival Rating of

Timeliness of Performance

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

1. Been pro-active in contract monitoring and review?

2. Demonstrated a responsive and cooperative working relationship with the Contracting Officer and Project staff?

3. Promptly notified the Contracting Officer of potential problems?

Unsatisfactory

4. Used effective approaches and provided technical expertise and resources to solve contract problems?

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?

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

Comments: (Explain any ratings below Satisfactory)

Summary Adjectival

Rating of

Customer Satisfaction

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:____________________