Past Performance Questionnaire sample.doc

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CGC ZEPHYR DRY DOCK
Solicitation number
21108003A1029
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Past Performance Questionnaire

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PAST PERFORMANCE QUESTIONNAIRE

HSCG80-10-Q-3PA1357

USCGC ZEPHYR Dry Dock Repairs The Contractor shall submit this questionnaire to two references for completion and return to the U. S. Coast Guard, SFLC, Norfolk, Virginia, at the address listed below. The offeror is responsible for ensuring that the questionnaire is completed and returned no later than the closing date of this solicitation. If the contractor has Contractor Performance Reports in the National Institutes of Health (NIH) Contractor Performance System, those may be used instead of this questionnaire. If no questionnaires are submitted for a contractor and there are no NIH Contractor Performance Reports to review, the contractor will receive a neutral rating.

EVALUATION INSTRUCTIONS

You have been requested to provide contract-related information for dry dock repairs and alterations to the USCGC Zephyr (WPC-8) a 179 foot, FOOT CYCLONE CLASS PATROL COASTAL. Please provide your assessment of the company’s level of past performance on the contract for which you are a reference. Mark the appropriate block, indicating whether the contractor’s/subcontractor’s past performance was Unsatisfactory, Poor, Fair, Good, Excellent, or Outstanding using the following rating guidelines. Space is provided for comments.

Please send the completed form directly to the mailing address, e-mail address or fax number listed below.

Commander (MECPL)

Surfaces Forces Logistics Center Attn: Angel C Rhone 300 East Main Street, Suite 600

Norfolk, VA 23510-9102

Anthony.r.oliver@uscg.mil Fax: (757) 628-4640

RATING GUIDELINES

Quality of Product or Service

0 = Unsatisfactory 1 = Poor 2 = Fair 3 = Good 4 = Excellent 5 = Outstanding

Unsatisfactory
Non-conformances are jeopardizing the achievement of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards containing similar requirements.
Poor
Overall compliance requires significant Agency resources to ensure achievement of contract requirements.
Fair
Overall compliance requires minor Agency resources to ensure achievement of contract requirements.
Good
There are no, or very minimal, quality problems, and the Contractor has met the contract requirements.
Excellent
There are no quality issues, and the Contractor has substantially exceeded the contract performance requirements without commensurate additional costs to the Government.
Outstanding
The contractor has demonstrated an outstanding performance level that was significantly in excess of anticipated achievements and is commendable as an example for others, so that it justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Cost Control

0 = Unsatisfactory 1 = Poor 2 = Fair 3 = Good 4 = Excellent 5 = Outstanding

Unsatisfactory
Ability to manage cost issues is jeopardizing performance of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, this level of ability to manage cost issues constitutes a significant impediment in consideration for future awards.
Poor
Ability to manage cost issues requires significant Agency resources to ensure achievement of contract requirements.
Fair
Ability to control cost issues requires minor Agency resources to ensure achievement of contract requirements.
Good
There are no, or very minimal, cost management issues and the Contractor has met the contract requirements.
Excellent
There are no cost management issues and the Contractor has exceeded the contract requirements, achieving cost savings to the Government.
Outstanding
The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where the contractor achieved cost savings and performance clearly exceeds the performance levels described as "Excellent".

Timeliness of Performance

Unsatisfactory
Delays are jeopardizing the achievement of contract requirements, despite use of Agency resources. Recovery is not likely. If performance cannot be substantially corrected, it constitutes a significant impediment in consideration for future awards.
Poor
Delays require significant Agency resources to ensure achievement of contract requirements.
Fair
Delays require minor Agency resources to ensure achievement of contract requirements.
Good
There are no, or minimal, delays that impact achievement of contract requirements.
Excellent
There are no delays and the contractor has exceeded the agreed upon time schedule.
Outstanding
The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

Business Relations

Unsatisfactory
Response to inquiries and/or technical, service, administrative issues is not effective. If not substantially mitigated or corrected it should constitute a significant impediment in considerations for future awards.
Poor
Response to inquiries and/or technical, service, administrative issues is marginally effective.
Fair
Response to inquiries and/or technical, service, administrative issues is somewhat effective.
Good
Response to inquiries and/or technical, service, administrative issues is consistently effective.
Excellent
Response to inquiries and/or technical, service, administrative issues exceeds Government expectation.
Outstanding
The contractor has demonstrated an outstanding performance level that justifies adding a point to the score. It is expected that this rating will be used in those rare circumstances where contractor performance clearly exceeds the performance levels described as "Excellent".

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND 3.104

PAST PERFORMANCE QUESTIONNAIRE

Past Performance information is being requested on:

Name of Company being evaluated:

Address:

Contract Number:

Contract Type:

Period of Performance: From: To:

Total Contract Value: $ Description of Contract:

During the contract performance being evaluated, this firm was the ( Prime Contractor

( Subcontractor

Ratings used in the NIH Contractor Performance System will be used to evaluate Past Performance. See the Rating Guidelines above.

0
1
2
3
4
5
N/A
1.
Quality of Product or Service – please rate

Comments for Quality of Product or Service

2.
Cost Control – please rate

Comments for Cost Control – please rate

3.
Timeliness of Performance – please rate

Comments for Timeliness of Performance

4.
Business Relations – please rate

Comments for Business Relations

Subcontracts

Were Subcontracts involved? ____Yes ____No

Comments for Subcontracts

Customer Satisfaction

Was the contractor committed to customer satisfaction? ____Yes ____No

Comments for Customer Satisfaction

Past Performance Information Provided by:

Name/Title:

Agency/Company:

Address:

Phone: Fax:

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND 3.104

File details come from the government source that posted it. Updated .