Attachment 5 - PPQ.docx

PAST PERFORMANCE QUESTIONNAIRE

TO REFERENCE:

REFERENCE’S PHONE NUMBER:

REFERENCE’S EMAIL:

FROM REQUESTING FIRM:

Your assistance is requested in support of a source selection. The United States Coast Guard (USCG) is in the process of evaluating offers from companies capable of overhauling the Starboard and Port Rudders installed onboard the 87’ WBC.

Please complete this Questionnaire and forward a copy to Dana Solomon (Contract Specialist), at Dana.D.Solomon@uscg.mil.

SECTION I - CONTRACT INFORMATION

1. CONTRACTOR NAME & ADDRESS:

2. CONTRACT NO.:

3. DESCRIPTION OF CONTRACT REQUIREMENTS:

4. PERIOD OF PERFORMANCE :

5. COMPETITIVELY AWARDED (circle one) YES or NO

6. INITIAL CONTRACT VALUE (with options:

7. CURRENT CONTRACT VALUE (with options):

8. TYPE OF CONTRACT:

SECTION II - EVALUATION

3. EVALUATOR’S TITLE:

4. EVALUATOR’S PHONE NUMBER:

5. EVALUATOR’S EMAIL ADDRESS:

6. INDIVIDUAL RATINGS EVALUATION:

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

E 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 action taken by the contractor were highly effective.

VG 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.

S 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.

M 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.

U 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.

NA NOT APPLICABLE - Unable to provide a score as the question does not apply.

The Contractor demonstrated an understanding of the requirement

The Contractor provided a product or service that conformed to contract requirements, specifications, and standards of good workmanship.

Overall customer satisfaction with the quality of work?

Schedule

The tasks required under this effort were performed in a timely manner and in accordance with the period of performance of the contract

The Contractor was responsive to technical and/or contractual direction

Business Relations

The Contractor demonstrated effective management over the effort performed.

The Contractor maintained an open line of communication so that the Contracting Office was apprised of technical, pricing, and schedule issues.

Contractor was reasonable and cooperative in dealing with your staff

The Contractor dhe Contractor demonstrated emonstrated ability to meet forecasted costs and perform within contract costs

I am satisfied with the performance of the Contractor under this effort

7. Comments:

8. OVERALL EVALUATION RATING (circle one):

Overall Assessment: (a) EXCEPTIONAL (b) VERY GOOD (c) SATISFACTORY (d) MARGINAL (e) UNSATISFACTORY (f) NOT OBSERVED

9. Any unsatisfactory performance identified above has been shared with the contractor. ( ) Yes: written or oral ? ( ) No

10. Government Contracts ONLY: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes___ Default___ Convenience___ Pending Terminations___ No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

11. Would you have any reservations about soliciting this Contractor in the future or having them perform one of your critical and demanding programs?

Yes _____ No_ __

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

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