Past_Performance_Questionnaire.pdf

USCG PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor to complete Blocks 1-4 )

1. Contractor Information Firm Name: CAGE Code:

Address: DUNs:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other

(Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information

Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify):

Contract Title:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

4. Project Description:

Complexity of Work High Med Routine How is this project relevant to project of submission?

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information

Name:

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: USCG REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMIT DIRECTLY BACK TO THE

OFFEROR. THE OFFEROR WILL SUBMIT THECOMPLETED QUESTIONNAIRE TO USCG WITH THEIR PROPOSAL. THE

GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

RATING DEFINITION NOTE

(E) Exceptional Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the

Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating.

(VG) Very Good Performance meets contractual requirements and exceeds some to the Government’s/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the

Government/Owner.

(S) Satisfactory Performance meets minimum 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.

A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract.

Contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

(M) Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor's proposed actions appear only marginally effective or were not fully implemented.

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

(U) Unsatisfactory Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the

Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating.

ADJECTIVAL RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

Contractor Information (Firm Name):

Client Information (Name):

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

a) Quality of technical data/report preparation efforts E VG S M U N

b) Ability to meet quality standards specified for technical performance E VG S M U N

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance. If there were no problems, circle N.

E VG S M U N

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements.

E VG S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones.

b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract

E VG S M U N

3. CUSTOMER SATISFACTION:

a) To what extent were the end users satisfied with the project? E VG S M U N

b) Contractor was reasonable and cooperative in dealing with your staff

(including the ability to successfully resolve disagreements/disputes;

responsiveness to administrative reports, businesslike and communication)

c) Overall customer satisfaction E VG S M U N

4. MANAGEMENT/ PERSONNEL/LABOR

a) Effectiveness of management, including management of subcontractors, ?

E VG S M U N

b) Ability to hire, apply, and retain a qualified workforce to this effort E VG S M U N

E VG S M U N

c) Knowledge/expertise demonstrated by contractor personnel E VG S M U N

d) Ability to simultaneously manage multiple project elements with multiple disciplines

E VG S M U N

e) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government/contract issuing company changes

E VG S M U N

f) Effectiveness of overall management

E VG S M U N

5. COST/FINANCIAL MANAGEMENT

a) Ability to meet the terms and conditions within the contractually agreed price(s)?

Contractor Information (Firm Name):

Client Information (Name):

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

E VG S M U N

c) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

Yes

No

d) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

Yes

No

6. SAFETY/SECURITY

a) Contractor complied with all safety requirements.

E

VG

S

M

U

N

b) Contractor complied with all security requirements for the project and personnel security requirements.

E VG S M U N

7. GENERAL

a) Ability to successfully respond to emergency and/or surge situations

(including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

E

VG

S

M

U

N

b) Compliance with contractual terms/provisions (explain if specific issues) E VG S M U N

c) Would you hire or work with this firm again? (If no, please explain below) Yes No

d) In summary, provide an overall rating for the work performed by this contractor.

Please provide responses to the questions above (if applicable) and/or additional remarks.

Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):