PAST_PERFORMANCE_QUESTIONNAIRE_-_15_Sep_15.docx

PAST PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a vendor evaluation in support of solicitation # DTFR5315R00115

Please complete this questionnaire and email to corey.scott@dot.gov

Desired Response Date: October 5th , 2015

When complete, the information on this form is SOURCE SELECTION INFORMATION (FAR 2.101 & 3.104) and shall be protected accordingly.

TO BE COMPLETED BY OFFEROR

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. CONTRACT VALUE (with options): $

6. CONTRACT TYPE: (FFP,CPFF, T&M, etc.)

7. BRIEF DESCRIPTION OF CONTRACT REQUIREMENTS:

THIS SECTION IS TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION ( Project Manager/ COR/ Other) AND ORGANIZATION:

b. EVALUATOR'S PHONE NUMBER:

c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

A. Quality of Products and Services – Please provide a statement regarding the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards).

B. Performance – Please provide a statement regarding the contractor’s performance for the project.

C. Schedule – Please provide a statement regarding the timeliness of contractor against the schedule of deliverables.

D. Customer Satisfaction – Please provide a statement regarding the contractor’s responsiveness to customer needs.

E. Area for Improvement – If you had to describe one area for improvement, what would it be? Please state the significance.