Atch 3 - Past Performance Questionnaire in pdf.pdf

SOURCE SELECTION SENSITIVE (when completed)

PAST PERFORMANCE QUESTIONNAIRE

Attachment 3

DTFH61-10-R-00010

Reference Information: Provide the following information for the Organization that performed the referenced work:

Prime or SubOfferor’s Name:

Offeror’s POC Name:

Offeror’s Information

Solicitation Number:

FHWA RFP #DTFH61-10-R-00010, “Technical Support for Highway Safety.”

Organization/Person Providing the Reference Information: Provide the following information for the Organization and Person/Point of Contact (POC) providing the reference (to assist us in tracking responses received and resolving any conflicts in the evaluation process if necessary):

Organization Name:

Questionnaire Completion Date:

Name of Contact:

Contact Numbers:

Telephone:

Facsimile:

Organization/Office:

Reference

Position Title:

Reference Project Information: Provide the following information about the referenced project.

Customer Organization/Office:

Project Title:

Reference’s Period of Involvement:

Type of Contract:

Period of Project Performance:

Start Date:

Length:

Reference Project

Contract Value:

Initial:

Current:

NOTE: THIS INFORMATION WILL BE KEPT CONFIDENTIAL

SOURCE SELECTION SENSITIVE (when completed)

PAST PERFORMANCE QUESTIONNAIRE

Attachment 3

DTFH61-10-R-00010

For the following questions, please circle/check the appropriate rating. Comment lines are provided for additional information if the #2 or #1 rating is given (however the comment lines may be used to provide any additional information deemed noteworthy).

High

Low

1.

QUALITY OF SERVICE:

This area deals with compliance of contract requirements, to include appropriateness of personnel and technical excellence.

2.

TIMELINESS OF PERFORMANCE:

This area deals with the contractor’s ability to meet milestones and delivery schedules, to include responsiveness to technical direction, completion of efforts on time including wrap-up and contract administration.

3.

PRICE/COST CONTROL:

This area deals with the contractor’s ability to control price/cost escalation during performance to include appropriate budgetary estimates, current/accurate/complete billings/invoices, relationship of negotiated costs to actual, claim submissions, cost efficiencies, and change order issues.

4.

CUSTOMER SATISFACTION:

This area deals with the contractor’s commitment to satisfaction and cooperative/reasonable businesslike behavior with own staff and customers to include: effective management, responsiveness to contract requirements, operates with honesty and integrity, prompt notification of problems, flexible and proactive qualities, effective contractor-recommended solutions, and effective subcontracting and teaming arrangements.

Comments (attach additional page(s) as necessary):

GENERAL INFORMATION: Please provide answers to the following questions.

5. Has the contractor ever been given a cure notice, show cause notice, suspension of progress payments, or other letters directing the correction of a performance problem; or has this contract been partially or completely terminated, or is there any pending termination actions? ( ) No ( ) Yes If yes: ( ) Default ( ) Convenience; and please explain:

6. Changes in contract dollar value throughout the life of the contract are/were attributable, for the most part, to:

( ) Government-issued change orders ( ) claims submitted by the contractor ( ) other Government actions ( ) other contractor actions (please explain below)

7. Based on this contractor’s overall performance, would you award this contractor another Government contract?

( ) Yes ( ) No If no, please explain:

8. If any of the above responses are based on adverse past performance, have you discussed it with the contractor and has the contractor had an opportunity to comment?

( ) Not Applicable ( ) Yes ( ) No If yes or no, please explain: