ATTACHMENT-_J_-4_Past_Performance_Questionnaire.docx

Request for Proposal (RFP), DTFT6015R00003 Financial Management Oversight Program

ATTACHMENT # 4

A. 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 Questionnaires by 4:30PM Eastern Standard Time on July 8, 2015.

PART I. (To be completed by the Offeror)

A. CONTRACT IDENTIFICATION

Organization:

Name:

Title:

Date:

Telephone Number Address:

Fax Number:

E-mail Address:

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. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and 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. Maintain Program Execution within Costs

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

· Satisfactory

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

3. Timeliness of Performance for Services and Product Deliverables, including the Administrative Aspects of Performance.

· 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. Ability to Resolve Technical and Manufacturing Problems Quickly and Effectively

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

· Satisfactory

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

6. Overall Satisfaction

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

8. 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:

9. Respondent Identification. Please provide the following information:

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/Description of Services or Items Purchased:

Total contract value:

PART III. SUBMISSION INFORMATION

Please return this completed Questionnaire via e-mail @ Robyn.Jones@dot.gov by 4:30 Eastern Standard time on July 8, 2015.