Attachment 4 - Past Performance Questionnaire.pdf

Past Performance Questionnaire

U.S. COAST GUARD

OPERATIONAL LOGISTICS COMMAND (LOGCOM)

CONTRACTOR EVALUATION FORM

The United States Coast Guard, Operational Logistics Command is currently procuring Housing Maintenancne Services at United States Coast Guard Training Center, located in Cape May, New Jersey under solicitation 70Z08426RDL950001. As a result, we are performing a past performance survey and reference investigation on potential contractors for the upcoming contract.

The information contained herein is considered “Source Selection Information” in accordance with FAR 3.104. Therefore, it is asked that you treat it accordingly. While the results of the overall past performance survey may be discussed with the contractor, FAR 15.609 and 15.1004 prohibits the release of the name of the individual responding to the survey.

Responses to this questionnaire should be UPLOADED to DHS Marketplace.

Should you have any questions concerning this survey, please contact information provided in solicitation

This portion is to be completed by the Offeror.

Contract Number: ______________________________________________________________ Offeror’s Company Name:

Address: ______________________________________________________________________ Telephone/Fax Number: _________________________________________________________ Point of Contact: _______________________________________________________________ Email: _______________________________________________________________________ Was work performed as a subcontractor under a prime contract? Yes No If yes, include:

Prime Contract Number: _________________________________________________________ Prime Contractor’s Name: ________________________________________________________ Address: ______________________________________________________________________ Telephone/Fax Number: _________________________________________________________ Point of Contact: _______________________________________________________________ Email: _______________________________________________________________________

Offeror Name: ___________________________ Solicitation# 70Z08426RDL950001

Project Title and Detailed Description of Work for which the Contractor was responsible to perform:

This portion is to be completed by the Respondent

Name and Title of Evaluator: ______________________________________________________ Company Name: _______________________________________________________________ Address: ______________________________________________________________________ Telephone/Fax Number: _________________________________________________________ Point of Contact: _______________________________________________________________ Email: ________________________________________________________________________

1. Contractor performed as Prime Contractor Subcontractor Key Personnel

2. The description of work as stated above accurately or does not accurately describe the work that was performed by Contractor being rated.

3. The contract was IAW (check all that apply): FFP CR T&M IDIQ SCA Davis Bacon Sole Source Subcontracting

Offeror Name: ___________________________ Solicitation# 70Z08426RDL950001

4. The total dollar value awarded: ________________________________________________

5. The total dollar value performed to date: _________________________________________

6. The Period of Performance awarded: ___________________________________________

7. The Period of Performance performed to date: ____________________________________

Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF E, G, M or U.

E Exceptional Performance meets contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

G Very Good Performance meets contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

S 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 were satisfactory.

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 or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

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 a serious problem(s) for which the contractor’s corrective actions appear or were ineffective

N Neutral Performance was not observed or not applicable to the current effort being reported against.

Offeror Name: ___________________________ Solicitation# 70Z08426RDL950001

Place an “X” in the appropriate column using the definitions matrix above.

The contractor: E G S M U N

QUALITY

1 Followed approved quality control plan.

2 Provided effective quality control and/or inspection procedures to meet contract requirements.

3 Corrected deficiencies in timely manner and pursuant to their quality control procedures.

4 Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

SCHEDULE

1 Developed realistic progress schedules.

2 Met established project schedules.

3 Provided timely resolution of warranty defects.

4 Paid subcontractors/suppliers in a timely manner.

COST CONTROL

1 Provided accurate and complete line item cost proposals including all aspects of work required for each task.

2 Managed Government furnished materials and supplies effectively and not in a wasteful manner

MANAGEMENT

1 Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

2 Home office participated in solving significant local problems.

3 Delegated authority to project managers and supervisors commensurate with contract requirements.

4 Provided timely resolution of contract discrepancies.

5 Identified problems as they occurred.

6 Suggested alternative approaches to problems.

7 Displayed initiative to solve problems.

8. Was responsive to contract changes.

9 Provided adequate project supervision.

10 Managed Program w/Integration & Coordination of the customer.

11 Managed Key Personnel 12 Managed Subcontracts 13 Integrity/Ethics Program 14 Reasonable and Cooperative in Behavior with Government personnel

REGULATORY

1 Complied with Environmental laws and regulations 2 Complied with Labor laws and regulations 3 Complied with other regulations and codes and safety requirements 4 How would you rate the contractor's overall performance?

Was the contractor ever issued a cure or show cause notice under the Contract discrepancy reports (or equivalent) frequent YES/NO

ADDITIONAL COMMENTS ON ANY RATING ELEMENT CAN BE MADE BELOW:

Offeror Name: ___________________________ Solicitation# 70Z08426RDL950001

End of Survey