Attachment X - Past Performance Questionnaire.pdf

Attachment X

Past Performance Questionnaire

U.S. DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

CG-9121-1

1430A Kristina Way

Chesapeake, VA 23326

I. INSTRUCTIONS

The company (i.e., contractor) 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 by the person completing the PPQ. Please 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. We are thanking you in advance for your time, effort, and cooperation in responding to this questionnaire.

Please submit the completed form to the Contract Specialist and Contracting Officer via the following method: (1) E-mail to Takira.M.Floyd@uscg.mil and Heather.M.Wastella@uscg.mil.

Please contact the Contract Specialist, (Takira Floyd), at (757) 413-7351 if you have any questions.

The completed PPQ is due on or before 9 December 2022 at 4:30 PM Eastern, unless the due date is extended via a Solicitation Amendment.

II. GENERAL INFORMATION

A. PAST PERFORMANCE EVALUATOR & ORGANIZATION/COMPANY

INFORMATION

1 Your Name:

2 Your Title:

Your Organization/ Company Name:

4 Address:

5 Your Phone Number:

6 Your Fax Number:

7 Your E-mail Address:

8 Date:

9 Your Signature:

mailto:Takira.M.Floyd@uscg.mil mailto:Takira.M.Floyd@uscg.mil

B. CONTRACTOR NAME & CONTRACT IDENTIFICATION

1 Name of Contractor being evaluated:

Type of Instrument (e.g., Contract, Purchase Order, Task Order, Other):

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):

Role of Contractor listed in #1 above

Prime Contractor

8 Description of Service/Supply:

9 Competitive (Y/N):

10 Follow-On (Y/N):

11 Date of Award:

Initial Contract Dollar Value (w/Options):

13 Final Contract Dollar Value (w/Options):

14 Period of Performance:

15 Place(s) of Performance:

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):

RATING DESCRIPTION

Exceptional

Performance meets contractual requirements and exceeds many to your organization’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.

Very Good

Performance meets contractual requirements and exceeds some to your organization’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

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 appear or were satisfactory.

Marginal

Performance does not meet some contractual requirements. The contractual performance of the evaluation area being evaluated 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.

Unsatisfactory

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the evaluation area being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

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

A. Quality of Product or Service. Assess the contractor’s conformance to contract requirements, specifications and standards of good workmanship (e.g., specified technical, professional, environmental, or safety and health standards). List and assess any sub-elements to indicate different efforts where appropriate. For example: Are reports/data accurate? Does the service provided meet the specifications of the contract? Does the contractor’s work measure up to commonly accepted technical or professional standards? What degree of Government technical direction was required to solve problems that arise during performance?

RATING Exceptional Very Good Satisfactory Marginal Unsatisfactory N/A

Check

Comment(s):

B. Schedule. Assess 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 effect the schedule variance). For example: Is the Contractor completing the services in a timely manner? Did the Contractor adequately schedule the work? Has the Contractor met administrative milestone dates?

Has the Contractor meet physical milestone dates specified by contract, or agreed to, in the project schedule? If the schedule has slipped through the Contractor’s fault or negligence, has the Contractor taken appropriate corrective action of its own volition? Has the Contractor furnish all required deliverables on or ahead of schedule? Has the Contractor furnished updated project schedules on a timely basis?

C. Management. Assess the integration and coordination of all activity needed to execute the contract, specifically the timeliness, completeness and quality of problem identification, corrective action plans, Offeror submittals, the contractor’s history of reasonable and cooperative behavior (to include timely identification and resolution of issues in controversy), customer satisfaction, timely award and management of subcontracts. Is the contractor oriented toward the customer? Is interaction between the contractor and your organization satisfactory, or does it need improvement? Assess the contractor’s performance in selecting, retaining, supporting, and replacing, when necessary, key personnel. For example, how well did the contractor match the qualifications of the key position, as described in the contract, with the person who filled the key position? Did the contractor support key personnel so they were able to work effectively? If a key person did not perform well, what action was taken by the contractor to correct this? If a replacement of a key person was necessary, did the replacement meet or exceed the qualifications of the position as described in the contract schedule?

V. SUMMARY

Would your organization/company award another contract to this Contractor (or use the services of the Contractor again)? Yes / No

In summary, if you care to, please give your overall assessment of this Contractor.

Do you have any additional comments to add?