ATTACHMENT-3_PAST_PERFORMANCE_QUESTIONNAIRE_PPQ_032118.doc

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Attached to
DRYDOCK USCGC ADELIE 87333
Solicitation number
70Z080-18-Q-P4594700
Issued by

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ATTACHEMENT-3 Past Performacne Questionnaire (PP!Q)

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ATTACHMENT-2_SPECIFICICATION_USCGC_ADELIE_87333_REV0.pdf PDF
COMBINED_SYNOPSIS_032118_ADELIE_DD_POP_26JUL-28SEP18__60_DAYS_Rev0__dtd_012618.pdf PDF
ATTACHMENT-1_SCHEDULED_OF_SERVICE_PRICING_SHEET.xls XLS spreadsheet

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ATTACHMENT-3

U.S. DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

SURFACE FORCE LOGISTIC CENTER (SFLC), CPD-1 PBPL

300 EAST MAIN STREET, SUITE 600

NORFOLK, VA 23510-9112

CONTRACTOR PAST PERFORMANCE QUESTIONNAIRE (PPQ)

PROJECT: Dry-dock Availability for USCGC ADELIE (87333)

I. INSTRUCTIONS

The Company 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 PO by the person completing the PPQ. **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. The US Coast Guard appreciates for your time, effort, and cooperation in responding to this questionnaire.

Sincerely, Nancy Brinkman

Contracting Officer

DHS/USCG/CPD1/PBPL

Nancy.M.Brinkman@uscg.mil Please complete and submit this form to Nancy Brinkman before April 24, 2018 at 0800 Eastern Standard Time and send via E-mail to: Nancy.M.Brinkman@uscg.mil

II. GENERAL INFORMATION

A.

PAST PERFORMANCE EVALUATOR & ORGANIZATION/COMPANY INFORMATION

1
Your Name:
2
Your Title:
3
Your Organization/

Company Name:

4
Address:
5
Your Phone Number:
6
Your Fax Number:
7
Your E-mail Address:
8
Date:
9
Your Signature:

B.

CONTRACTOR NAME & CONTRACT IDENTIFICATION

1
Name of Contractor being evaluated:
2
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):
7
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:
12
Initial Contract Dollar Value (w/Options):
13
Final Contract Dollar Value (w/Options):
14
Period of Performance:
15
Place(s) of Performance:
16
Complexity of Work

(e.g., difficult, routine):

17
If applicable , type and extent of subcontracting:

III. GENERAL GUIDANCE

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

0 = Unsatisfactory
Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.
1 = Marginal
Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.
2 = Satisfactory
Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
3 = Very Good
Performance meets contractual requirements and exceeds some to the Governments benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
4 = Exceptional
Performance meets contractual requirements and exceeds many to the Governments benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

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

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

Comments:

2.
Schedule - Timeliness of Performance – please rate

Comments:

0
1
2
3
4
N/A
3.
Cost Control – please rate

Comments:

4.
Business Relations – please rate

Comments:

5
Management of Key Personnel – please rate

Comments:

6
Utilization of Small Business

Comments:

Were Subcontractors Used? ____Yes _____No

Comments for Subcontracts

V. SUMMARY

Would your organization/company award another contract to this Contractor (or use the services of the Contractor again)? FORMCHECKBOX Yes / FORMCHECKBOX No In summary, if you care to, please give your overall assessment of this Contractor.

Do you have any additional comments to add?

Thank you for your valuable input.

Sincerely, Nancy Brinkman

“Source Selection Information—See FAR 2.101 and 3.104.”

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