RFP Attachment 4 - Mail-In Performance Questionnaire.docx

RFP ATTACHMENT 4

Mail-in Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN, THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 2.101 AND 3.104 TO: Government agency or commercial organization (i.e., customer) with knowledge of the Offeror's past performance.

Please complete this questionnaire, which concerns the past performance of a contractor or subcontractor who is doing business (or has done business) with you, and is interested in doing business with the U.S. Department of Labor (DOL). Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages. Responses will be treated as source selection sensitive information. The contractor who provided DOL with your name as a reference was informed, via a solicitation provision, that by listing you as a reference and requesting your submission of the questionnaire, they are authorizing you to release information to DOL relative to their past performance, whether it is positive or negative information.

Email the completed questionnaire to the attention of the responsible Contracting Officer. The Offeror must fill in the solicitation number, fax number, email address, and name of Contracting Officer below, prior to providing you with the questionnaire, or provide you with the information to fill in. Your completed questionnaire must be provided directly to the Contracting Officer from you. DOL will not accept completed questionnaires sent from the Offeror.

RFP Attachment 4 - 1605C5-21-R-00001

Offeror: Complete SECTION 1, then e-mail questionnaire to the customer points of contact listed on the Past Performance Information Sheet for the contract identified.

Offeror’s Evaluator: Complete SECTIONS 2-3 and e-mail to: lee.jasmine@bls.gov and chaney.lasondia@bls.gov.

(DO NOT PROVIDE COPY BACK TO THE OFFEROR)

SECTION 1: CONTRACTOR IDENTIFICATION

A. Contractor *Please identify if you are a teaming member or subcontractor with the prime

B. Prime Contractor Cage Code

C. Contract Number

D. Contract Type

No

F. Period of Performance

G. Initial Contract Cost ($)

H. Current/Final Contract Cost ($)

I. Reasons for differences between initial contract cost and final contract costs (enter below):

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or Agency Name

B. Customer or Agency Description (if applicable)

C. Geographic description of services under this contract, i.e., local, nationwide, worldwide, other Command

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's Name

B. Evaluator's Title

C. Evaluator's Phone/Fax Number

D. Number of years evaluator worked on subject contract

SECTION 4: NARRATIVE SUMMARY

What were the contractor’s greatest strengths in the performance of the contract?

What were the contractor’s greatest weaknesses in the performance of the contract?

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