Past Performance Questionnairefinal - .docx

PERFORMANCE QUESTIONNAIRE

CERTIFICATION

The government representative will inform the party (evaluator) providing the information that “By law, the Government will not disclose the names of individuals providing reference information during discussions with the Contractor identified below:

(*Note – Return directly to Contract Specialist, Sharon Burgess-Anderson. at sharon.b.anderson@dot.gov)

Evaluator’s Printed Name Title/Role (e.g., Program Manager, Contracting Officer)

Evaluator’s Mailing Address (Agency, Bldg. /Rm., Street or P.O. Box, City, State, Zip)

INSTRUCTIONS

Two forms are provided below to document the government’s conversation with the reference provided by the contractor: 1) Performance Rating Form; and 2) Supplemental Comment Form. The evaluators will be requested to use the following standards in arriving at their rating.

· Exceptional/Excellent: Exceeds specific performance or capability in a beneficial way; has a high probability of satisfying the requirement; and has no significant weakness.

· Acceptable/Good: Meets evaluation standards; has good probability of satisfying the requirement; and any weakness can be readily corrected.

· Marginal/Fair: Fails to meet evaluation standards; has a low probability of satisfying the requirements; and has significant deficiencies but correctable.

· Unacceptable/Poor: Fails to meet a minimum requirement; and deficiency requires a major revision to make it correct.

· Other: If the element is not applicable, indicate with “N/A.” If no data has been obtained or additional comments are provided, please note in this column.

Performance Rating Form

NAME OF COMPANY EVALUATED:

ADDRESS OF COMPANY EVALUATED:

TYPE OF SERVICES PERFORMED:

NAME OF GOVERNMENT REPRESENTATIVE DOCUMENTING EVALUATION

OFFICE AND TELEPHONE NUMBER OF GOVERNMENT REPRESENTATIVE

1. Quality of Service

- Compliance with contract requirements

- Accuracy of reports

- Appropriateness of personnel

- Technical excellence

2.Cost Control

- Within budget

- Current, accurate and complete billings

- Costs properly allocated

- Unallowable costs not billed

- Relationship of negotiated costs to actual

- Cost efficiencies

3. Timeliness of Performance

- Meets interim milestones

- Reliable

- Stays on schedule despite problems

- Responsive to technical direction

- Completes work on time, including wrap-up and contract administration

- No liquidated damages assessed

4. Business Relations

- Effective management

- Use of performance-based management techniques

- Business-like concern for the customer's interests

- Effective management and selection of subcontractors

- Effective small/small disadvantaged business subcontracting program

- Reasonable/cooperative behavior

- Effective use of technology in management and communication

- Flexible

- Minimal staff turnover

- Maintains high employee morale

- Resolves disagreements without being unnecessarily litigious.

5. Customer Service

- Understands and embraces service and program goals

- Team approach with the customer

- Satisfaction of end users with the contractor’s service

- Positive customer feedback

- Prompt responses

- Courteous interactions

- Effective escalations and referrals

- Initiative and proactive improvements

- Creative service strategies

Supplemental Comment Form

Document any additional comments by the evaluator regarding the performance element ratings in the appropriate spaces below. Please add additional pages as necessary.

1. Quality of Service

2.Cost Control

3. Timeliness of Performance

4. Business Relations

5. Customer Service

(Continued from previous page) Page 5 of 5 Page

Attachment 2

DTNH22-11-R-00450