Sample_Past_Performance_questionaire.pdf

ATTACHMENT J.7 - SAMPLE PAST PERFORMANCE QUESTIONAIRE

SECTION 1: CONTRACTOR INFORMATION (to be completed by the Contractor requesting evaluation prior to mailing)

A. Contractor’s Name and Address:

B. Point of Contact:

C. Phone Number:

D. Contract Number:

E. Project Title or Description of Work performed under this project:

F. Contract Type: Firm Fixed Price Indefinite Delivery/Indefinite Quantity Task Order

Cost Reimbursement

G. Project Award Date: Schedule Completion Date:

Current/Final Completion Date:

H. Project Award Amount: Current/Final Project Amount:

I. Contractor being evaluated performed as the Prime Contractor Subcontractor Supplier

J. Authorization is hereby granted to provide the information requested in SECTION 3 of this Questionnaire.

(Signature)

(Name and Title of Authorized Official) (Date)

SECTION 2: RESPONDENT INFORMATION (to be completed by respondent)

EVALUATED BY:

(Signature) (Date)

(Typed or Printed Name)

(Title)

(Phone Number)

(Address)

SECTION 3: PAST PERFORMANCE INFORMATION: Choose the number on the scale of 5 to 1 that most accurately describes the Contractor’s performance or situation. Please provide a narrative explanation for any ratings of 2 or 1.

Please see Table 42-1 – Evaluation Rating Definitions and Table 42-2 – Evaluation Ratings Definitions (For the Small Business Subcontracting Factor, when FAR 52,219-9 is used) below when completing this Past Performance Questionnaire.

5 = Exceptional 4 = Very Good 3 = Satisfactory 2 = Marginal 1 = Unsatisfactory

OVERALL CUSTOMER SATISFACTION

Customer would have no reservations in awarding another contract to the Contractor.

5 4 3 2 1

TECHNICAL (QUALITY OF PRODUCT OR SERVICE)

1 How would you rate the skill level, technical competence, and quality of

Contractor personnel?

5 4 3 2 1

2 How would you rate the Contractor’s ability to identify and mitigate technical and programmatic risks?

5 4 3 2 1

3 How would you rate the Contractor’s compliance with technical requirements and performance standards

5 4 3 2 1

4 How would you rate the Contractor’s performance in addressing problems and mitigating reoccurrence of the problem?

5 4 3 2 1

5 How would you rate the Contractor’s responsiveness to changes in technical direction?

5 4 3 2 1

6 How would you rate the accuracy and completeness of the Contractor’s reports and documentation?

5 4 3 2 1

COST CONTROL

1 How would you rate the Contractor’s ability to apply cost efficient practices?

5 4 3 2 1

2 How would you rate the timeliness, accuracy, and completeness of the Contractor’s cost reports and documentation?

5 4 3 2 1

3 How would you rate the Contractor’s ability to customer cost/billing information?

5 4 3 2 1

SCHEDULE/TIMELINESS

1 How would you rate the Contractor’s completion of major tasks or key project milestones on schedule?

5 4 3 2 1

2 How would you rate the timeliness, accuracy, and completeness of the Contractor’s technical and management reports and documentation submissions?

5 4 3 2 1

MANAGEMENT OR BUSINESS RELATIONS

1 How would you rate the quality of the management support assigned? 5 4 3 2 1 2 How would you rate the Contractor’s ability to effectively coordinate, integrate, and manage subcontractors?

5 4 3 2 1

3 How would you rate the Contractor’s efficiency in interfacing and communicating with the Government’s/Customer’s staff?

5 4 3 2 1

4 How would you rate the Contractor’s ability to recruit and retain qualified staff?

5 4 3 2 1

5 How would you rate the Contractor’s effectiveness to changes in technical direction?

5 4 3 2 1

6 How would you rate the Contractor’s management effectiveness in dealing with emergency situations?

5 4 3 2 1

7 How would you rate the Contractor’s demonstration of a strong commitment to integrity and business ethics?

5 4 3 2 1

8 How would you rate the Contractor’s reasonableness, cooperation, and commitment to customer service?

5 4 3 2 1

SMALL BUSINESS SUBCONTRACTING

1 Contractor provided experience/qualified managers and supervisors with the technical and administrative abilities needed to meet contract and/or task order requirements.

5 4 3 2 1

2 Contractor hired quality subcontractors and effectively managed and coordinated their work.

5 4 3 2 1

3 Contractor hired, maintained, and replaced, as necessary, subcontractors/suppliers.

5 4 3 2 1

4 Contractor paid subcontractors, as required. 5 4 3 2 1

REMARKS:

SECTION 4: NARRATIVE SUMMARY:

1. What were the Contractor’s greatest strengths in the performance of the contract?

2. What were the Contractor’s greatest weaknesses in the performance of the contract?

3. Please provide any additional comment concerning the Contractor’s performance.

4. GOVERNMENT CONTRACTS ONLY: Has or was this contract partially or completely terminated for default or convenience or are there any pending terminations?

Yes No Default Convenience Pending Termination

If yes, please explain.

5. Were there any performance issues regarding the Contractor’s work? If yes, please explain.

Please return this completed questionnaire to:

E-Mail address: carl.chin@dot.gov mailto:carl.chin@dot.gov

TABLE 42-1—EVALUATION RATING DEFINITIONS.

Rating Definition Note

(a) Exceptional

Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

To justify an Exceptional rating, identify multiple significant events and state how they were of benefit to the Government. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

(b) Very Good

Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

To justify a Very Good rating, identify a significant event and state how it was a benefit to the Government. There should have been no significant weaknesses identified.

(c) Satisfactory

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract/order. There should have been NO significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be evaluated with a rating lower than Satisfactory solely for not performing beyond the requirements of the contract/order.

(d) Marginal

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

To justify Marginal performance, identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the Government. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter).

(e) Unsatisfactory

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

To justify an Unsatisfactory rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the Government. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g., management, quality, safety, or environmental deficiency reports, or letters).

NOTE 1: Plus or minus signs may be used to indicate an improving (+) or worsening (-) trend insufficient to change the evaluation status.

NOTE 2: N/A (not applicable) should be used if the ratings are not going to be applied to a particular area for evaluation.

TABLE 42-2—EVALUATION RATINGS DEFINITIONS (FOR THE SMALL BUSINESS SUBCONTRACTING EVALUATION FACTOR, WHEN

52.219-9 IS USED).

Rating Definition Note

(a) Exceptional Exceeded all statutory goals or goals as negotiated. Had exceptional success with initiatives to assist, promote, and utilize small business (SB), small disadvantaged business (SDB), women-owned small business (WOSB), HUBZone small business, veteran-owned small business (VOSB) and service disabled veteran owned small business (SDVOSB). Complied with FAR 52.219-8, Utilization of Small Business Concerns. Exceeded any other small business participation requirements incorporated in the contract/order, including the use of small businesses in mission critical aspects of the program. Went above and beyond the required elements of the subcontracting plan and other small business requirements of the contract/order. Completed and submitted Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate and timely manner.

To justify an Exceptional rating, identify multiple significant events and state how they were a benefit to small business utilization. A singular benefit, however, could be of such magnitude that it constitutes an Exceptional rating. Small businesses should be given meaningful and innovative work directly related to the contract, and opportunities should not be limited to indirect work such as cleaning offices, supplies, landscaping, etc. Also, there should have been no significant weaknesses identified.

(b) Very Good Met all of the statutory goals or goals as negotiated. Had significant success with initiatives to assist, promote and utilize SB, SDB, WOSB, HUBZone, VOSB, and SDVOSB. Complied with FAR 52.219-8, Utilization of Small Business Concerns. Met or exceeded any other small business participation requirements incorporated in the contract/order, including the use of small businesses in mission critical aspects of the program. Endeavored to go above and beyond the required elements of the subcontracting plan. Completed and submitted Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate and timely manner.

To justify a Very Good rating, identify a significant event and state how it was a benefit to small business utilization. Small businesses should be given meaningful and innovative opportunities to participate as subcontractors for work directly related to the contract, and opportunities should not be limited to indirect work such as cleaning offices, supplies, landscaping, etc. There should be no significant weaknesses identified.

(c) Satisfactory Demonstrated a good faith effort to meet all of the negotiated subcontracting goals in the various socio-economic categories for the current period. Complied with FAR 52.219-8, Utilization of Small Business Concerns. Met any other small business participation requirements included in the contract/order. Fulfilled the requirements of the subcontracting plan included in the contract/order. Completed and submitted Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate and timely manner.

To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor has addressed or taken corrective action. There should have been no significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract/order.

(d) Marginal Deficient in meeting key subcontracting plan elements. Deficient in complying with FAR 52.219-8, Utilization of Small Business Concerns, and any other small business participation requirements in the contract/order. Did not submit Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate or timely manner. Failed to satisfy one or more requirements of a corrective action plan currently in place;

however, does show an interest in bringing performance to a satisfactory level and has demonstrated a commitment to apply the necessary resources to do so. Required a corrective action plan.

To justify Marginal performance, identify a significant event that the contractor had trouble overcoming and how it impacted small business utilization. A Marginal rating should be supported by referencing the actions taken by the government that notified the contractor of the contractual deficiency.

(e) Unsatisfactory Noncompliant with FAR 52.219-8 and 52.219-9, and any other small business participation requirements in the contract/order.

Did not submit Individual Subcontract Reports and/or Summary Subcontract Reports in an accurate or timely manner. Showed little interest in bringing performance to a satisfactory level or is generally uncooperative. Required a corrective action plan.

To justify an Unsatisfactory rating, identify multiple significant events that the contractor had trouble overcoming and state how it impacted small business utilization. A singular problem, however, could be of such serious magnitude that it alone constitutes an Unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the actions taken by the government to notify the contractor of the deficiencies. When an Unsatisfactory rating is justified, the contracting officer must consider whether the contractor made a good faith effort to comply with the requirements of the subcontracting plan required by FAR 52.219-9 and follow the procedures outlined in FAR 52.219-16, Liquidated Damages-Subcontracting Plan.

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NOTE 1: Plus or minus signs may be used to indicate an improving (+) or worsening (-) trend insufficient to change evaluation status.

NOTE 2: Generally, zero percent is not a goal unless the contracting officer determined when negotiating the subcontracting plan that no subcontracting opportunities exist in a particular socio-economic category. In such cases, the contractor shall be considered to have met the goal for any socio-economic category where the goal negotiated in the plan was zero.

ATTACHMENT J.7 - SAMPLE PAST PERFORMANCE QUESTIONAIRE