Atch4-PPSurvey.doc

DTFR53-17-R-00002, Attachment 4 – Past Performance Survey Form

Attachment 4

PAST PERFORMANCE SURVEY FORM

CONTRACTOR PAST PERFORMANCE SURVEY

INTRODUCTION

PART I - ADMINISTRATION – Contractor Past Performance Survey (To be completed by the Offeror and submitted with its Offer/Submission)

Name of Agency/Business: U.S Department of Transportation/Federal Railroad Administration Reference Conducting Assessment: Isaac Rosier, Jr., Contracting Officer

Name of Offeror/Applicant Making Submission Under RFP No. DTFR53-17-R-00002

Name of Organization/Person To Whom Reference Applies If Other Than Offeror/Applicant:

Contract or Project Title:

Nature of the work:

Contract No. Delivery/Task Order No.

Performance Period(s): Base Period- from to & Base plus All Options - from to

Dollar Value(s): Base Period - & Base plus All Options -

Contract Type and Method of Contracting: (Check all that apply) [ ] Full & Open Competition [ ] Other Than Full & Open Competition [ ] Negotiated [ ] Sealed Bid [ ] Simplified Acquisition [ ] FSS/MAS [ ] 2-Step or Phased [ ] Firm Fixed Price [ ] Other FP type (specify) [ ] Cost (no fee) [ ] Cost Plus Fixed Fee [ ] Other Cost Reimbursement type (specify) [ ] Other Contract type (specify) [ ] SBA 8(a) [ ] SBIR [ ] HUBZone Set-Aside [ ] SDB Price Adjustment [ ] Small Business Set-Aside

PART II - RELEVANCY/PERSPECTIVE – Contractor Past Performance Survey (To be completed by Offeror/Applicant and submitted with its Offer/Submission) For Part II, the Offeror shall complete and insert a single page that addresses the following three areas of inquiry: Description of Prior Contract Services, Relevancy, and Problem Resolution and Quality Honors. The text of the Offeror’s responses for all three inquiries combined shall not exceed one page.

Description of Prior Contract Services: Provide a short description of services the Offeror furnished in the referenced contract evaluated herein.

(Recommend 5 -10 lines.)

Relevancy: Describe how the referenced contract evaluated herein is relevant (in terms of scope, magnitude, cost, human resources, or other aspects) to the project proposed in the Offeror’s proposal. Identify whether the Offeror was the prime contractor or a major subcontractor (in terms of total contract cost, 25% or more), or served in some other capacity/role or relationship. Provide name, point of contact and phone number of prime contractor, if other than Offeror.

(Recommend 20 -25 lines.)

Problem Resolution and Quality Honors: The Offeror may describe problems encountered in the identified contract and the demonstrated effectiveness of the Offeror’s corrective actions. Identify any Federal Government contracts/orders, of any type, at any dollar value, held by the Offeror which were terminated for cause or for default (partial or complete) within the past three (3) years and subsequent corrective action. The Offeror may also describe any specific quality awards or quality certifications received in connection with the referenced contract.

(Recommend 15 -20 lines.)

NOTE: Do not return or furnish a copy of this Part III to the subject Offeror/contractor.

The evaluator/respondent should complete this part and e-mail, mail or FAX it directly to: FRA, Office of Acquisition Services, Room W34-206, 1200 New Jersey Avenue SE, Washington, DC 20590.

If you have any questions, please contact Isaac Rosier, Jr., Tel: 202/493-6149, FAX: 202-493-6172 or E-Mail: isaac.rosier@dot.gov

PART III - EVALUATOR’S ASSESSMENT

(To be completed and signed by referred Evaluator/Respondent for RFP No. DTFR53-17-R-00002)

Contractor Name: _____ Contract No. ________________________ 1.

Quality of Product or Service - The Offeror is to be evaluated on its compliance with contract requirements, accuracy of reports, technical excellence to include quality awards/certificates, or other quality-related contract standards.

(Check one)

(Check one)

Use remaining space (and additional cross-referenced sheets, as necessary) to

(1) Explain the rationale for the assigned adjectival/numerical rating (i.e., recount specific extraordinary or poor contractor performance, or problems and responses that support assessment and (2) Describe the basis for any “no” responses to questions.

2.

Timeliness of Performance - The Offeror is to be evaluated on meeting milestones, reliability, responsiveness to technical direction, deliverables completed on time, adherence to contract schedules including contract administration, or other time-related contract standards.

(Check one)

Use remaining space (and additional cross-referenced sheets, as necessary) to

(1) Explain the rationale for the assigned adjectival/numerical rating (i.e., recount specific extraordinary or poor contractor performance, or problems and responses that support assessment) , and (2) Describe the basis for any “no” responses to questions.

Contractor: ________ Contract No. __________________________ 3.

Cost Control - The Offeror is to be evaluated on its ability to perform within or below budget, use of cost efficiencies, relationship of negotiated costs to actuals, submission of reasonably priced change proposals, and providing current, accurate, and complete billing in a timely fashion. For fixed price contracts, this area assesses whether the contractor met the original price/cost estimated or needed to negotiate cost changes to meet program requirements.

(Check one)

COST

CONTROL

Corresponding Adjectival & Numerical Ratings (Circle one)

Use remaining space (and additional cross-referenced sheets, as necessary) to

(1) Explain the rationale for the assigned adjectival/numerical rating (i.e., recount specific extraordinary or poor contractor performance, or problems and responses that support assessment) , and (2) Describe the basis for any “no” responses to questions.

4.

Business Relations - The Offeror is to be evaluated on its ability to provide effective management, meet applicable subcontractor and small, small disadvantaged, and women-owned business goals, cooperative and proactive behavior with the technical representative(s) and Contracting Officer, flexibility, responsiveness to inquires, problem resolution, and customer satisfaction with the overall performance, and final product or services.

(Check one)

[ ] n/a to assessment period

BUSINESS

RELATIONS

Corresponding Adjectival & Numerical Ratings (Circle one)

Use remaining space (and additional cross-referenced sheets, as necessary) to

(1) Explain the rationale for the assigned adjectival/numerical rating (i.e., recount specific extraordinary or poor contractor performance, or problems and responses that support assessment) , and (2) Describe the basis for any “n” responses to questions.

5. General Information: Please provide answers to the following questions.

a. 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 in the past 3 years?

[ ] YES [ ] NO If yes, please explain.

b. Have you terminated this contractor for default within the past 3 years, or are there any pending termination actions? [ ] YES [ ] NO If yes please explain.

c. Based on the contractor’s overall performance, would you award them another contract?

[ ] YES [ ] NO If no, please explain.

d. Have you discussed any adverse past performance problems with the contractor and given them an opportunity to comment? Do you file past performance information in a database that the Government’s Contracting Officer may search? Please explain.

6. Evaluator’s Identification/Signature

Contractor: _________ Contract No. ________________________ Name of Evaluator/Respondent:

Position or Title:

(e.g., COR, Task Monitor, Project Manager, etc.):

Address of Activity/Business:

Telephone No. Fax No. Email Address:

Signature: Date:

(To be completed by Government Interviewer only when survey is completed on behalf of

Evaluator/Respondent. Otherwise leave blank.)

Name of Interviewer:

Telephone No. Fax No. Email Address:

Signature: Date of Interview:

The Federal Railroad Administration (FRA) is currently conducting a competitive procurement solicitation under which each prospective Offeror has been requested to identify Government agencies or commercial business firms it has previously contracted with or to whom it is currently under contract, to serve as potential references for its past performance record. You are being asked to complete and return this Contractor Past Performance Survey. Parts I and II are to be completed and returned by the Offeror with its submission. Part III should be completed by the evaluator/respondent and forwarded directly to FRA (See Note below regarding Part III transmittal.) You may also be contacted by an FRA procurement official to arrange a telephone interview, using the survey as the focal point of the interview.

To ensure frank and open evaluations and expressions of opinions by evaluators, all parties are advised that the identity of the evaluators completing the survey will be held in confidence and will not be released or disclosed to the contractor or to anyone outside the Government. However, as specified under Federal Acquisition Regulation 15.306, conditions may exist in which the contractor may be provided an opportunity to discuss adverse past performance information on which the Offeror has not had a previous opportunity to comment. Any relevant contractor performance/customer evaluations previously prepared within the last three years by the agency/firm providing this reference, and subsequent responses or rebuttals from the Offeror/contractor, may be requested to augment or furnished in lieu of this survey or interview.

NOTE: Part III – “Evaluator’s Assessment” of this survey should NOT be returned or furnished in a copy to the subject Offeror/contractor. The evaluator/respondent submits Part III directly to: � HYPERLINK "mailto:isaac.rosier@dot.gov" �isaac.rosier@dot.gov�. If you have any questions, Mr. Rosier may also be reached by phone at (202) 493-6149.

Exceptional (5) - Performance in the respective area of evaluation, consistently and reliably far exceeded standards or expectations as set forth in the contract, or as prior experience and knowledge of the industry would suggest or dictate. There were essentially no major problems, weaknesses, or deficiencies of consequence, nor negative performances issues as it applies to the respective area of evaluation. The contractual performance of the element or sub�element being assessed was accomplished with few minor problems for which the contractor took highly effective and timely corrective action.

Very Good (4) -Performance in the respective area of evaluation, consistently and reliably exceeded standards or expectations as set forth in the contract, or as prior experience and knowledge of the industry would suggest or dictate. There were essentially no major problems, weaknesses, or deficiencies of consequence, nor negative performances issues as it applies to the respective area of evaluation. The contractual performance of the element or sub�element being assessed was accomplished with some minor problems for which the contractor took effective and timely corrective action.

Satisfactory (3) - Performance in the respective area of evaluation, consistently and reliably met standards or expectations as set forth in the contract, or as prior experience and knowledge of the industry would suggest or dictate. There were essentially no major problems, weaknesses, or deficiencies of consequence, nor negative performances issues as it applies to the respective area of evaluation. The contractual performance of the element or sub�element being assessed was accomplished with some minor problems for which the contractor took competent and timely corrective action.

Marginal (2) - Performance in the respective area of evaluation, did not meet standards or expectations as set forth in the contract, or as prior experience and knowledge of the industry would suggest or dictate. There were problems, weaknesses, or deficiencies of consequence, or negative performances issues as it applies to the respective area of evaluation. The contractual performance of the element or sub�element being assessed was accomplished with some minor problems and one or more major problems for which the contractor took minimal or ineffectual and/or untimely corrective action.

Unsatisfactory (1) - Performance in the respective area of evaluation, failed to meet standards or expectations as set forth in the contract, or as prior experience and knowledge of the industry would suggest or dictate. There were problems, weaknesses, or deficiencies of consequence, or negative performances issues as it applies to the respective area of evaluation. The contractual performance of the element or sub�element being assessed was accomplished with numerous minor and numerous major problems for which the contractor took virtually no, or minimal or ineffectual, and/or untimely corrective action.

EVALUATION RATING GUIDELINES

SOURCE SELECTION INFORMATION

The disclosure of which is restricted – See FAR 2.101 and 3.104