13R000002_Sec._J_Attach_J.15_Past_Performance.pdf

U.S. Department of Transportation Attachment J.15 Pipeline and Hazardous Materials Safety Administration Past Performance Questionnaire

RFP: DTPH56-13-R-000002 J.15-1

CONTRACTOR PAST PERFORMANCE QUESTIONNAIRE

Final Interim – Period Report From: To:

Name and Address of Contractor Being Evaluated:

2. Contract /Task Number: ______________

3. Contract Value: $ (Base Plus Options)

4. Contract Award Date:

5. Contract Completion Date: ______

6. Type of Contract: (Check all that apply) - FP FPI FP-EPA CPFF Completion CPFF - Term CPIF CPAF ID/IQ BOA Requirements Labor-Hour T&M SBSA 8(a) SBIR

Sealed Bid Negotiated Competitive Non-Competitive

7. Description of Requirement:

8. Ratings: Summarize contractor performance and circle in the column on the right of the number which corresponds to the performance rating for each rating category. Please see page for explanation of rating scale.

a. Quality of Product/Service Comments:

b. Cost Control Comments:

c. Timeliness Comments:

d. Business Relations Comments: 0

e. Overall Satisfaction Rating Comments 0

9. Would you select this firm again? Please explain.

RFP: DTPH56-13-R-000002 J.15-2

CONTRACTOR PAST PERFORMANCE QUESTIONNAIRE INSTRUCTIONS

Top of Form: Indicate whether the report is a final or interim (annual) report, and give dates for the period of time being covered.

Block 1: Identify the name and address of the prime contractor.

Block 2: Identify contract number of the contract being evaluated

Block 3: Contract value shall include base plus options. If funding was increased or decreased during the evaluation period, the value in this block should indicate the change.

Block 4: Identify date that contract was awarded.

Block 5: Identify completion date for contract or anticipated contract completion date.

Block 6: All items that apply should be checked.

Block 7: Provide a clear and concise description of the work being done under the contract and identify the key performance indicators.

Block 8: Circle the rating in the far right column and provide brief narrative for each of the categories rated. Indicate the contract requirements that were exceeded or were not met by the contractor and by how much.

Block 9: If given a choice, please explain why you would or would not select the contractor for this contract again.

Block 10: The program office person most familiar with the contractor’s performance would sign this block. The rating is a combined program office, contracting officer decision.

Block 11: The contracting officer’s signature certifies concurrence with this rating.

10. Program Officer Signature and Date:

(or name/title of rater)

Phone/Fax/Internet Address:

11. Contracting Officer Signature and Date:

(or name/title of person-concurrence of rating):

Phone/Fax/Internet Address:

RFP: DTPH56-13-R-000002 J.15-3

Block 8 - RATING DEFINITIONS

0 – Unsatisfactory - Performance failed to satisfy the minimum contract or task requirements, technical or otherwise. Areas of deficiency could include, but are not limited to failure to meet schedules; failure to adequately estimate or control costs; inadequate staffing; lack of cooperation and responsiveness.

1 – Minimally Acceptable – Performance generally met minimum contract or task requirements, but significant issues arose which required expenditure of time or resources by the Government to ensure the requirements were met. Areas of re-work could include late or incomplete deliverables; poor quality of work;

lack of communication; cost control problems; contract administration problems.

2 – Satisfactory – Met all technical and administrative contract or task requirements. Minor issues arose which were resolved with minimal expenditure of time or resources.

3 – Good – Met all contract or task requirements and exceeded minimal requirements in some areas. No problems with quality, timeliness, or cost issues. Management was responsive.

4 – Exceptional – Performance significantly exceeded minimal technical requirements and met all other contract requirements. Areas in which performance was exceptional could include early deliveries; creative approach; innovative technology; effective and proactive management and administration; commitment to customer satisfaction.

Block 8 – COMMENT ELEMENTS BY CATEGORY

(a) Quality of product/service

- Compliance with contract or task requirements;

- Accuracy of reports;

- Appropriateness of contractor personnel assigned to the contract or task; and

- Technical excellence of delivered supplies or services.

(b) Cost Control

- Current, accurate, and complete billings;

- The relationship of negotiated cost to actuals;

- Cost containment initiatives; and

- The number and cause of change orders issued.

(c) Timeliness of Performance

- Whether the contractor met interim milestones;

- Contractor’s responsiveness to technical direction;

- Contractor’s responsiveness to contract change orders and administrative requirements;

- Whether the contract/task was completed on time, including wrap-up and contract administration.

(d) Business Relations

- Whether the contractor effectively managed the contract/task effort;

- How responsive the contractor was to contract requirements;

- How promptly the contractor notified the Government of problems;

- Whether the contractor was reasonable and cooperative;

- How flexible the contractor was;

- Whether the contractor was proactive;

- The effectiveness of contractor-recommended solutions; and

- Whether the contractor effectively implemented socioeconomic programs.

(e) Customer Satisfaction

- Satisfaction of end users with the contractor’s service