DTRT57-13-R-20007_A0003_Attachment_4.docx

Solicitation No. DTRT57-13-R-20007 8(a) Communications and Operations Research and Analysis (CORA) Support Services

SOURCE SELECTION SENSITIVE

Solicitation No. DTRT57-13-R-20007, Amendment No. A0003 Attachment 4

SECTION J, PART III, ATTACHMENT J.5

PAST PERFORMANCE QUESTIONNAIRE FOR NON-FEDERAL REFERENCES

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DTRT57-13-R-20007

Amendment A0003 Attachment 4

Solicitation No. DTRT57-13-R-20007 8(a) Communications and Operations Research and Analysis (CORA) Support Services

SOURCE SELECTION SENSITIVE

This is a past performance questionnaire for the U.S. Department of Transportation/Research and Innovative Technology Administration (RITA)/Volpe National Transportation Systems Center (Volpe Center) to obtain past performance information on the Contractor/Offeror listed below. You should have received this questionnaire along with a Client Authorization Letter from the Contractor/Offeror identified below asking for your cooperation in completing this questionnaire. Information obtained in this questionnaire is for the sole purpose of evaluating the Contractor/Offeror’s past performance history to assist the Volpe Center in determining the best value for award of a contract and task order resulting from this solicitation. As a reviewer, your participation in this questionnaire is greatly appreciated.

INSTRUCTIONS:

To complete this questionnaire, the Contractor/Offeror should:

1. Complete SECTION 1, CONTRACT DATA on the next page of this questionnaire.

2. Forward this questionnaire along with a Client Authorization Letter, to the reviewer.

To complete this questionnaire, the reviewer should:

1. Review SECTION 1, CONTRACT DATA.

2. Review and complete SECTION 2, CONTACT INFORMATION.

3. Complete SECTION 3, RATINGS by evaluating and assigning a rating as defined below for quality, timeliness of performance, cost control, business relations, and management of key personnel. Include a narrative for each rating if appropriate.

4. Return the questionnaire to the Volpe Center Contracting Officer by email (Alison.Fecht@dot.gov) by 2:00 pm EDT on Tuesday, July 9, 2013.

SECTION 1: CONTRACT DATA

Name and Address of Contractor:

Point of Contact Name:

Point of Contact Phone Number:

DUNS Number:

Contract Title:

Contract Number:

Contract Value:

Contract Type:

Contract Award Date:

Contract Reporting Period (Start):

Contract Reporting Period (End):

Agency/Firm Name:

To be completed only if the questionnaire is being completed for a task order:

Task Order Title:

Task Order Number:

Task Order Value:

Task Order Type:

Task Order Award Date:

Task Order Reporting Period (Start):

Task Order Reporting Period (End):

The remainder of this form is to be completed by the reference and returned to the Volpe Center Contracting Officer as instructed in the Client Authorization Letter.

SECTION 2: CONTACT INFORMATION

Agency/ Firm:

Name:

Title:

E-mail:

Phone:

Mailing Address:

Fax:

The Contractor being evaluated performed as the: |_| Prime Contractor |_| Subcontractor

SECTION 3: RATINGS

*The rating definitions and notes come directly from the Contractor Performance Assessment Reporting System (CPARS) at http://www.cpars.gov/cparsfiles/pdfs/CPARSQualityChecklist.pdf.

5-Exceptional

Please check the appropriate Rating for each Performance Element:

Quality of Product or Service

Contractors Schedule/ Timeliness

Cost Control

Business Relations/ Management

Utilization of Small Business

Provide remarks on exceptional performance:

(Provide data supporting this observation. You may continue on additional sheets if necessary.)

Provide remarks on unsatisfactory performance:

(Provide data supporting this observation. You may continue on additional sheets if necessary.)

Identify corporate affiliations with the Contractor:

Would you conduct business with this Contractor again?