Attachment_J.2_Past_Performance_Questionnaire.docx
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- Solicitation number
- DTNH2215R00016
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Past Performance Questionnaire
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PAST PERFORMANCE QUESTIONNAIRE
TO: Government agency or commercial organization (i.e., customer) with knowledge on Offeror's past performance.
1. Please complete this questionnaire, which concerns the past performance of a contractor or subcontractor who is doing business (or has done business) with you, and is interested in doing business with the National Highway Traffic Safety Administration (NHTSA). Responses will be treated as source selection sensitive information. By law, the Government will not disclose the names of individuals providing reference information.
Email the completed questionnaire to the attention of the responsible NHTSA Contracting Officer below. Your completed questionnaire must be provided directly to the NHTSA Contracting Officer from you.
NHTSA Solicitation Number: DTNH22-15-R-00016 Attention Contracting Specialist: Omari Fennell Email: omari.fennell.ctr@dot.gov and NHTSAOAM@dot.gov
2. Please complete the following identifying information and past performance assessment:
A. Contractor:
B. Contract Number:
C. Period of Performance:
D. Total Contract Amount (Including any Options):
E. Describe contract objectives:
3. Explanation of performance levels:
PERFORMANCE LEVEL
| OUTSTANDING |
| Performance meets contractual requirements and exceeds many requirements. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| VERY GOOD |
| Performance meets contractual requirements and exceeds some requirements. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| SATISFACTORY |
| Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory. |
| MARGINAL |
| Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented. |
| UNSATISFCTORY |
| Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective. |
| NOT APPLICABLE |
| Unable to provide a score. Performance in this area not applicable to effort assessed. |
4. Using the performance levels above, mark the appropriate box for each item on the questionnaire and provide supporting narrative.
Performance Element
| Outstanding |
| Very Good |
| Satisfactory |
| Marginal |
| Unsatisfactory |
| Not Applicable |
1.Quality of Service
- Compliance with contract requirements
- Accuracy of reports
- Appropriateness of personnel
- Technical excellence
Comments:
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
Comments:
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
Comments:
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
Comments:
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
Comments:
5. Please provide the name, title, Government agency or commercial organization, phone number, and email address of the person completing this questionnaire.
Name of Respondent:
Title:
Government agency/commercial organization:
Telephone Number:
Email address:
Thank you for your assistance.
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