Attachment 3 - Past Performance Questionnaire.pdf

Attachment 3

Past Performance Questionnaire (Complete one form per reference)

Please fill out the applicable information.

SECTION 1 – TO BE COMPLETED BY OFFEROR

Offeror:

Contract Number:

BPA Number:

Order Number:

__ Prime or _____ Subcontractor (Check one)

Dollar Amount:$0.00 Date Completed: MM/DD/YY

Contract Type:

(Check One) _____ Fixed Price _____ Cost Reimbursement _____ Other (Specify)

Item/Service Description:

Contract Quantity/Period of Performance:

Customer/Business/Agency Name:

Customer POC (Note: Ensure POC information is valid and current) Name:

Address:

Phone:

E-mail:

SECTION 2 – TO BE COMPLETED BY THE REFERENCE

The offeror in Section 1 provided you as reference for a solicitation they are a party to. Please complete Section 2 and return to Miranda Smith at Miranda.V.Smith@uscg.mil and Adam Petty at Adam F. Petty1@uscg.mil no later than July 28, 2025, by 11:00 AM EST.

Evaluation In TABLE 3 indicate the contractor’s past performance for each category area and overall rating by identifying with an “x” or check mark for the most appropriate rating according to the Performance Rating Definitions in Table 2. Provide rationale, including specific examples, as appropriate, to support your ratings in the space provided for comments for each category area.

If more space is needed, continue your comments in the “Additional Comments” section at the end of this questionnaire.

TABLE 2 - PERFORMANCE RATINGS DEFINITIONS

Rating Description

Exceptional Performance meets contractual requirements and exceeds many to the Government's benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good Performance meets contractual requirements and exceeds some to the Government’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

TABLE 1- Category Area

Rating Description

Quality of Product/Service

Assessment based on the contractor’s conformance to contract requirements, specifications and standards of good workmanship (e.g., commonly accepted technical, professional, environmental, or safety and health standards).

Schedule Assessment based on 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 affect the schedule variance).

Cost Assessment based on the contractor’s effectiveness in forecasting, managing, and controlling contract cost.

***If contract is/was Firm-Fixed Price or Firm-Fixed Price with Economic Price Adjustment, please mark “Not Rated”***

Management (Business Relations)

Assessment based on 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 of issues in controversy), customer satisfaction, timely award and management of subcontracts.

mailto:Miranda.V.Smith@uscg.mil

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.

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.

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.

Not Rated Not applicable or has no history.

TABLE 3 - PERFORMANCE RATINGS

Category Rating

1. Quality of Product/Service:

__Exceptional __Very Good __Satisfactory __Marginal __Unsatisfactory __Not Rated

2. Schedule: __Exceptional __Very Good __Satisfactory __Marginal __Unsatisfactory __Not Rated

3. Cost:

***If contract is/was Firm-Fixed Price or Firm-Fixed Price with Economic Price Adjustment, please mark “Not Rated”***

__Exceptional __Very Good __Satisfactory __Marginal __Unsatisfactory __Not Rated

4. Management (Business Relations): __Exceptional __Very Good __Satisfactory __Marginal __Unsatisfactory __Not Rated

Additional Comments:

In TABLE 3 indicate the contractor’s past performance for each category area and overall rating by identifying with an “x” or check mark for the most appropriate rating according to the Performance Rating Definitions in Table 2. Provide rationale, inc...