Attachment 4 - Past Performance Questionnaire.pdf

US Coast Guard National Security Guard Services (NSGC)

RFP 70Z023 21 R PGC00100-ATCH_IV Page 1 of 5

Past Performance Questionnaire

U.S. DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

HQ-CG-9121

1430a KRISTINA WAY

CHESAPEAKE, VA 23326

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

I. INSTRUCTIONS

The company (i.e., contractor) that sent you this questionnaire intends to submit an offer in response to a U.S. Coast Guard solicitation and has identified you as a reference to validate their performance. This PPQ must be completed by the person most familiar with the contractors’ performance on a present or previous contract and then submitted directly to the U.S. Coast Guard by the person completing the PPQ. Please DO NOT send the completed PPQ to the contractor being evaluated. In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information. We are thanking you in advance for your time, effort, and cooperation in responding to this questionnaire.

Please submit the completed form to the Point of Contact via one of the following methods: (1) E-mail to Jamison.W.Harned@uscg.mil and (2) Clenton.A.Shanks@uscg.mil

The completed PPQ is due on or before the “Offer Due Date/Local Time”, unless the due date is extended via a Solicitation Amendment.

II. GENERAL INFORMATION

A. PAST PERFORMANCE EVALUATOR & ORGANIZATION/COMPANY

INFORMATION

1 Your Name:

2 Your Title:

Your Organization/ Company Name:

4 Address

5 Your Phone Number:

6 Your Fax Number:

7 Your E-mail Address:

8 Date:

9 Your Signature:

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B. CONTRACTOR NAME & CONTRACT IDENTIFICATION

1 Name of Contractor being evaluated:

Type of Instrument (e.g., Contract, Purchase Order, Task Order, Other):

3 Pricing Type (e.g., Fixed Price, Time & Material, Cost Reimbursement, Other):

4 Contract or Reference Number:

5 Subcontract Number (if applicable):

6 Order Number (if applicable):

Role of Contractor (Prime or Sub) (if sub, also provide name of prime)

8 Description of Service/Supply:

9 Competitive (Y/N):

10 Follow-On (Y/N):

11 Date of Award:

Initial Contract Dollar Value (w/Options):

13 Final Contract Dollar Value (w/Options):

14 Period of Performance:

15 Place(s) of Performance:

Complexity of Work (e.g., difficult, routine):

17 If applicable , type and extent of subcontracting:

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III. GENERAL GUIDANCE

Please use the following ratings to score the performance elements below (assessments should reflect only contractor-liable performance):

RATING DESCRIPTION

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.

Unsatisfactory

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

IV. EVALUATION: Rate the contractor in each of the following Evaluation Areas.

A. Quality of Product or Service. Assess the contractor’s conformance to contract requirements, specifications and standards of good workmanship (e.g., specified technical, professional, environmental, or safety and health standards). List and assess any sub-elements to indicate different efforts where appropriate. For example: Are reports/data accurate? Does the service provided meet the specifications of the contract? Does the contractor’s work measure up to commonly accepted technical or professional standards? Assess the degree of direction given by your organization to solve problems that arise during performance.

Quality of Product or Service RATING Satisfactory Unsatisfactory N/A

Check

Comment(s):

B. Schedule. Assess the timeliness of the contractor against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements (e.g., efforts that contribute to or effect the schedule variance). This assessment of the contractor’s adherence to the required delivery schedule should include the contractor’s efforts during the assessment period that contributes to or effect the schedule variance. This element applies to contract closeout activities as well as contract performance.

Instances of adverse actions such as the assessment of liquidated damages, or issuance of Cure Notices, Show Cause Notices, and Delinquency Notices are indicators of problems which may have resulted in variance to the contract schedule and should therefore be noted in the evaluation.

Schedule

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C. Cost Control. Assess the contractor’s effectiveness in forecasting, managing, and controlling contract cost. For example, does the contractor keep within the total estimated cost (what is the relationship of the negotiated costs and budgeted costs to actuals)? Did the contractor do anything innovative that resulted in cost savings? Were billings current, accurate and complete? Are the contractor’s budgetary internal controls adequate?

Cost Control

D. Business Relations. Assess the integration and coordination of all activity needed to execute the contract, specifically the timeliness, completeness and quality of problem identification, corrective action plans, proposal submittals, the contractor’s history of reasonable and cooperative behavior (to include timely identification and resolution of issues in controversy), and customer satisfaction. Is the contractor oriented toward the customer? Is interaction between the contractor and your organization satisfactory, or does it need improvement? Also, in making the assessment, include the adequacy of the contractor’s accounting, billing, and estimating systems; and the contractor’s management of, if a substantial amount of property has been provided to the contractor under the contract.

Business Relations

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E. Management of Key Personnel. Assess the contractor’s performance in selecting, retaining, supporting, and replacing, when necessary, key personnel. For example, how well did the contractor match the qualifications of the key position, as described in the contract, with the person who filled the key position? Did the contractor support key personnel so they were able to work effectively? If a key person did not perform well, what action was taken by the contractor to correct this? If a replacement of a key person was necessary, did the replacement meet or exceed the qualifications of the position as described in the contract schedule?

Management of Key Personnel

V. SUMMARY

Would your organization/company award another contract to this Contractor (or use the services of the Contractor again)? Yes / No

In summary, if you care to, please give your overall assessment of this Contractor.

Do you have any additional comments to add?