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PAST PERFORMANCE QUESTIONNAIRE
TO: Government agency or commercial organization (i.e., customer) with knowledge of the Contractor's past performance.
1. Please complete this questionnaire, which concerns the past performance of a Contractor or Subcontractor who is doing business (or has done business) with you, and is interested in doing business with the U.S. Department of Labor (DOL). Handwritten responses are sufficient. If you need more space than provided, please attach additional pages. Responses will be treated as source selection sensitive information. The contractor who provided DOL with your name as a reference was informed, via a solicitation provision, that by listing you as a reference and requesting your submission of the questionnaire, they are authorizing you to release information to DOL relative to their past performance, whether it is positive or negative information.
Fax or email the completed questionnaire to the attention of the responsible Contracting Officer. The Contractor must fill in the Prime Contractor if they are subcontractor as part of the solicitation prior to providing you with the questionnaire, or provide you with the information to fill in. Your completed questionnaire must be provided directly to the Contracting Officer from you. DOL will not accept completed questionnaires sent from the Contractor.
Solicitation Number:
*ATTN: Contracting Officer:
*Email:
@dol.gov
| If this reference is for a proposed subcontractor, the Prime is: |
2. Please complete the following identifying information and past performance assessment:
| C. Period of Performance: |
| D. Total Contract Amount (Including any Options): |
E. CPARs/PIPPRs Available Yes ___ No ___
| F. Describe Product Acquired: |
3. Explanation of codes:
| E |
| EXCEPTIONAL - |
| Performance meets contractual requirements and exceeds most requirements. |
| V |
| VERY GOOD - |
| Performance meets contractual requirements and exceeds some requirements. |
| S |
| SATISFACTORY - |
| Performance meets contractual requirements. |
| U |
| UNSATISFACTORY - |
| Performance does not meet one or more contractual requirements. |
| N |
| NOT APPLICABLE - |
| Unable to provide a score. Performance in this area not applicable to effort assessed. |
4. Using the codes above, place an “x” next to the appropriate letter for each item on the questionnaire and provide supporting narrative.
ASSESSMENT ELEMENTS
(1) Quality of Service - The Contractor’s past performance clearly demonstrates the Contractor is compliant with contract requirements, accuracy of reports, and appropriateness of personnel technical expertise.
| Appropriate quality assurance and compliance in meeting performance requirements |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Early identification of problems and timely resolution |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Contractor’s problem tracking, reporting, and escalation |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Availability of support (during normal work hours) |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Responsiveness of the support personnel |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Quality of services provided by the support personnel |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
(2) Project Management Experience - The Contractor’s past performance clearly demonstrates the Contractor’s responsiveness, scheduling, contract management, cooperative and proactive behavior with Government representatives, and flexibility.
| Responsive to changing priorities or unique technical requirements |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Cooperation in solving problems |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Flexibility in Contractor’s business dealings with your organization |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Planning, estimating and scheduling in complex technical environments |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Responsiveness to your basic technical requirements and/or to minor changes in the technical requirements |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Contract compliance |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Subcontract administration (if applicable) |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Recruitment and retention of technical and management staff |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Minimize impact due to staff changes |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Cooperation with other contractors and Contractors |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
(3) Schedules, Milestone, Reports - The Contractor’s past performance clearly demonstrates the Contractor’s adherence to contract schedules, record of meeting milestones and delivery schedules, reliability, stays on schedule despite problems, completes work on time and responsiveness to technical direction. The Contractor's ability to report on financial matters, including timely and accurate reporting of monthly workload. (includes monthly reports and meetings).
| Contractor’s responsiveness to emergency situations |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Contractor’s ability to meet deadlines in accordance with the contract and agreed-upon schedules |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Accuracy and completeness of reports |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Accuracy, completeness, and timeliness of invoices and cost tracking |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Ability to control of costs (remain within budget, efficiencies) |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Extent to which Contractor met proposed cost estimates |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Contractor’s tendency to propose unnecessary changes with price increases |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
(4) Overall Satisfaction - The Contractor’s past performance references are satisfied with the Contractor’s overall service/performance: includes providing reasonable and cooperative behavior and commitment to customer satisfaction and demonstrated business-like concern for the interest of the customer. Did the contractor exhibit reasonable/cooperative behavior in dealing with problems? Rate the contractor's responsiveness to managing changes in providing replacement personnel.
| Understanding of the customer’s requirements |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Program Management support during non-emergency periods |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
| Program Management support during emergency periods |
| |_| E |
| |_| V |
| |_| S |
| |_| U |
| |_| N |
5. Please provide the name, title, Government agency or commercial organization, phone number, and email address of the person completing this questionnaire.
| Government agency/commercial organization |
Thank you for helping us in this matter.
Attachment 1: Subcontractor Consent Form
SUBCONTRACTOR CONSENT FORM
FOR THE RELEASE OF PAST PERFORMANCE INFORMATION
TO THE PRIME CONTRACTOR
Past performance information concerning subcontractors and teaming partners cannot be disclosed to a private party without the subcontractor's or teaming partner's consent because a prime contractor is a private party. The Government will need that consent before disclosing subcontractor past performance information to the prime during exchanges. In an effort to assist the Government in assessing your past performance relevancy and confidence, we request that the following consent form be completed by the major subcontractors identified in your proposal. The completed consent forms should be submitted as part of your Past Performance Volume.
Dear TBD
We are currently participating as a subcontractor with (prime contractor or name of entity providing proposal) in responding to the Department of the Labor, Washington, DC request for Proposal TBD for DOL IVR Support. We understand that the Government is placing increased emphasis on past performance in order to obtain best value in source selections. In order to facilitate the performance confidence assessment process we are signing this consent form to allow you to discuss our past performance information with the prime contractor during the source selection process.
| ________________________ | ________________________ | |
| Name | | Title |
| ________________________ | ________________________ | |
| Signature | | Date |
(Signature and Title of individual who has the authority to sign for and legally bind the company)
Company Name:
Address: