Attachment_J.2_Past_Performance_Questionnaire.pdf

NHTSA RFP DTNH2216R00036

Title: Examine the Feasibility of Standardize Field Test for

Marijuana Impairment: Laboratory Evaluation

Attachment J.2

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Attention of Contract Specialist Name: Vanessa Wallace

At: Vanessa.Wallace.ctr@@dot.gov or NHTSAOAM@dot.gov

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PAST 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:

NAME OF CONTRACTOR ADDRESS OF CONTRACTOR

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

Please provide the requested information on the firm listed above. Two forms are provided below to document the government’s conversation with and/or comments made by the individual providing a reference on the identified contractor: 1) Performance Rating Form; and 2) Supplemental Comment

Form. Each evaluator is requested to use the following standards in arriving at their rating.

Adjectival Rating Descriptions

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

Satisfactory: Meets evaluation standards; has good probability of satisfying the requirement;

and any weakness can be readily corrected.

Unsatisfactory: Fails to meet a minimum requirement; and deficiency requires a major revision to make it correct.

mailto:NHTSAOAM@dot.gov

Marijuana Impairment: Laboratory Evaluation

Attachment J.2

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Attention of Contract Specialist Name: Vanessa Wallace

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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.

Marijuana Impairment: Laboratory Evaluation

Attachment J.2

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Attention of Contract Specialist Name: Vanessa Wallace

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Performance Rating Form

NAME OF COMPANY EVALUATED:

ADDRESS OF COMPANY EVALUATED:

TYPE OF SERVICES PERFORMED:

NAME OF

EVALUATOR

EVALUATOR’S

COMPANY/AGENCY

DATE EVALUATION

PROVIDED

TIME EVALUATION

PROVIDED

NAME OF GOVERNMENT REPRESENTATIVE

DOCUMENTING EVALUATION

OFFICE AND TELEPHONE NUMBER OF

GOVERNMENT REPRESENTATIVE

Performance Element Outstanding Satisfactory Unsatisfactory Other

1. QUALITY OF TECHNICAL APPROACH

(For example: Were the services comprehensive, complete, and feasible? (Met the needs, performed successfully, and accommodated changing requirements.)

2. EFFECTIVE AND EFFICIENT USE OF RESOURCES

(For example: Was the contractor able to obtain in a timely manner the amount and type of personnel resources required to support the project, effectively train personnel to perform the work required for the project, and maintain the required workforce throughout the term of the contract?)

3. EFFECTIVE AND EFFICIENT USE OF SUBCONTRACTORS

(For example: Was the experience of the subcontractors directly applicable to the project, did the contractor successfully met subcontracting goals and objectives as related to small, woman-owned and small disadvantaged businesses, and did the contractor successfully utilize and manage all subcontractor resources?)

4. QUALITY OF PERFORMANCE/CUSTOMER

SATISFACTION

(For example: Was the contractor committed to customer satisfaction?)

5. BUSINESS BEHAVIOR

(For example: Was the contractor reasonable and cooperative at the corporate and program levels in response to changes in technical direction, correcting errors, poor performance, criticism/rejection of contract deliverables and other quality issues?)

6. COMMUNICATION

(For example: Did the contractor work and communicate well with contracting officers, contracting officer’s technical representatives, Marijuana Impairment: Laboratory Evaluation

Attachment J.2

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Attention of Contract Specialist Name: Vanessa Wallace

Page 4 of 5 Page end users, other contractors, subcontractors, and in-house staff?)

7. COST CONTROL

(For example: Was the contractor successful in planning and proposing realistic costs, monitoring performance, operating at or below budget, and implementing corrections/changes in a cost effective manner?)

Performance Rating Form (Continued) Performance Element Outstanding Satisfactory Unsatisfactory Other

8. TIMELINESS OF PERFORMANCE

(For example: Was the contractor successful in planning and proposing realistic schedules, monitoring performance, completing work on time, and implementing corrections/changes in a timely manner?)

9. UNDERSTANDING OF REQUIREMENTS

(For example: Did the contractor show an understanding of the scope of the requirements and an appreciation of the complexity of the requirements? And did the contractor effectively identify flaws, inconsistencies and other inaccuracies in your technical direction?)

FOR #10 Thru #15, PLEASE ANSWER “Yes” or “No”, as appropriate.

YES NO

10.

11.

12.

13.

14.

15.

Marijuana Impairment: Laboratory Evaluation

Attachment J.2

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Attention of Contract Specialist Name: Vanessa Wallace

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Additional 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.