Past Performance Questionnaire.docx

INTEGRATED PEST MANAGEMENT SERVICES

PAST PERFORMANCE QUESTIONNAIRE

The below contractor has identified you or your (Agency) company as a reference as having knowledge of or experience with the contractor’s past performance, which is requested for the above referenced solicitation. Please take a moment to complete this survey; your candid response(s) to this questionnaire will be of assistance in the source selection process. Therefore, it is important that the information you provide be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to a person who does.

Upon completion of the questionnaire, please email a copy to:

Nicole Price Contract Specialist Email: nicole.price@dot.gov Thank you for your assistance in the Past Performance evaluation process!

SECTION 1: CONTRACT IDENTIFICATION (To be completed by the Offeror)

1. Name of Contractor: _______________________________________ B. Contract#: __________________ C. Period of Performance w/Option Years.: Start Date: _________ End Date: _________ D. Total Contract Amount (include mods and options): $_________________________________________________ E. Description of service provided: _________________________________________________________________ F. Identification of Offeror’s Representative:

G. Evaluator (Respondent) Point of Contract:

Name and Title: ______________________________________________________________________________ Organization/Agency Name: ___________________________________________________________________ Phone#_________________________ Email Address: _____________________________________________ SECTION 2: EVALUATION (To be completed by Point of Contact – Respondent)

Please complete this questionnaire based on the following guidance:

1. Handwritten responses are sufficient. Please write legibly.

1. Indicate, based on the performance levels defined below, the contractor’s performance on the identified program. Assessments should reflect only contractor liable performance. The following is a definition of the rating levels:

PERFORMANCE LEVELS

Please return the completed questionnaire with the proposal package to: Nicole Price at nicole.price@dot.gov.

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

C1. Timeliness and accuracy of the Contractor fulfill financial responsibility for contract employees.

C2. Provide experienced managers and supervisors with technical and administrative abilities to meet contract requirements.

C3. Provide effective quality control/inspection procedures.

C4. Corrected deficiencies in a timely manner.

C5. Identified problems as the occurred.

C6. Suggested alternative approaches to problems.

C7. Displayed initiative to problem solving.

C8. Timeliness and accuracy of Contractor responsive to contract changes.

C9. Contractor’s overall performance.

E1. Ability to hire/apply a qualified highly specialized workforce to this effort.

E2. Ability to support the program with limited staff turnover.

E3. Ability to retain incumbent staffing upon award of contract.

E4. Contractor ability to smoothly transition resources and personnel.

Has/was this contract been partially or completely terminated for default or issued a cure or show cause notice?

___Yes ____Default ____Cure ____Show Cause ___No

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc.).

SECTION 3: REMARKS. Please provide any additional information you feel is important and not covered elsewhere.

How would you describe your organization’s experience with the contractor?

Has the contractor failed to deliver a service as part of an agreement?

Would your organization consider entering into a new business partnership with this contractor?

Would you have any reservations about soliciting this contractor in the future or having them perform one of the critical and demanding programs?

Would you award another contract to this contractor?

Evaluator’s Printed Name/ Title

Evaluator’s Signature Date