Attachment_L.2__Past_Performance_Questionnaire.docx

DTFT60-13-R-00001

Attachment L.2 Past Performance Questionnaire Triennial Review Past Performance Questionnaire

Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does. Please return the completed Questionnaire by December 4, 2012 by 4:30PM EST. Thank you.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

FAX Number:

Address:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent)

1. The contractor's record of conforming to specifications and to standards of good workmanship

· Exceeds Contractual Requirements (Explanation must be provided in Comments field below)

· Meets Contractual Requirements

· Failed to Meet Contractual Requirements (Explanation must be provided in Comments field below)

Comments:

2. The contractor's adherence to contract schedules, including administrative aspects of performance

3.

4.

5.

6.

7. aspects of performance

· Exceptional (Explanation must be provided in Comments field below)

· Satisfactory

· Unsatisfactory (Explanation must be provided in Comments field below)

3. The contractor's history of reasonable and cooperative behavior and commitment to customer satisfaction

· Exceeds Contractual Requirements (Explanation must be provided in Comments field below)

· Meets Contractual Requirements

· Failed to Meet Contractual Requirements (Explanation must be provided in Comments field below)

4. The contractor’s ability to maintain program budgets within a given task order

· Satisfactory

· Unsatisfactory (Explanation must be provided in Comments field below)

5. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest.

F. Overall Satisfaction.

· Extremely Satisfactory (Explanation must be provided in Comments field below)

G. General Comments. Provide any other relevant performance information.

H. Other Information Sources. Please provide the following information:

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

I. Respondent Identification. Please provide the following information:

Organization:

Name:

Title:

Date:

Telephone Number Address:

Fax Number:

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to Matthew Butner, Contract Specialist by email: matthew.butner@dot.gov or fax 202/366-3808.

Thank you for your assistance.