Attachment_D-PPQ.pdf

HSCG23-16-R-AHH005 | Attachment D

PPQ

Source Selection Sensitive – See FAR 3.104

HSCG23-16-R-AHH005

Past Performance Questionnaire

PART ONE: INSTRUCTIONS

The company who has provided you with this form is proposing on a Department of Homeland Security (DHS) solicitation to provide services to support H-65 Dolphin Short- Range Recovery (SRR) helicopter for the U.S. Coast Guard. Past Performance is an extremely important part of the evaluation criteria for this acquisition, so your input is very important. The information is to be provided directly to, the US Coast Guard Contracting Officer. This information will not be disclosed to the Offeror. Please provide an honest assessment and return the questionnaire, by e-mail, to the e-mail address shown below, no later than 1300 ET Monday 14 March 2016. If you have questions regarding this questionnaire, please contact Susan Ferralli at 202-475-3703.

Completed questionnaires should be emailed to the following addresses: Susan.Ferralli@uscg.mil and Jazmine.T.Gordon@uscg.mil .

GENERAL INFORMATION

1. VENDOR’S NAME AND ADDRESS 2. CUSTOMER ORGANIZATION

3. CONTRACT NUMBER: 2a. EVALUATOR

4. CONTRACT VALUE: _______________________ NAME:

TITLE:

PHONE NO:

5. CONTRACT AWARD DATE: 6. CONTRACT COMPLETION DATE:

7. CONTRACT TYPE (Circle All That Apply): 8. COMPLEXITY OF WORK (Circle One Response):

Fixed Price Cost-Plus Fixed Price Cost-Plus Award Fee DIFFICULT ROUTINE

T & M OTHER ______________________

9. BRIEF DESCRIPTION OF YOUR CONTRACT REQUIREMENTS:

SOURCE SELECTION SENSITIVE INFORMATION

mailto:Susan.Ferralli@uscg.mil mailto:Jazmine.T.Gordon@uscg.mil

PART TWO: VENDOR PERFORMANCE RATING

On the following pages, please summarize the Vendor’s performance in each rating factors. Each factor has a set of sub factors with four possible adjectival ratings. Determine the adjectival rating that most nearly represents your experience with this Vendor and indicate your assessment by placing an “X” under the appropriate heading. Vendor performance factors are:

A. CORPORATE COMMITMENT

B. QUALITY OF SERVICE

C. TIMELINESS OF PERFORMANCE

D. TEAMING ARRANGEMENTS

Adjectival ratings are defined below and should be used as a reference in assessing performance:

EXCEPTIONAL Performance meets contractual requirements and exceeds many to the Government’s benefit

VERY GOOD Performance meets contractual requirements and exceeds some to the Government’s benefit

SATISFACTORY Performance meets contractual requirements

MARGINAL Performance does not meet some contractual requirements

UNSATISFACTORY Performance does not meet most contractual requirements and recovery is not likely in a timely manner

CORPORATE COMMITMENT

Exceptional

Very Good

Satisfactory

Marginal

Unsat

Contractor’s ability to provide effective contract and project management?

Contractor’s ability to provide a systematic approach to provide the most current technologies, services and techniques available in the market place?

Contractor’s ability to understand and respond to user requirements?

Contractor’s ability to establish and maintain effective quality control standards and procedures?

QUALITY OF SERVICE

Contractor’s ability to provide quality goods/services?

Contractor’s ability to provide quality reports and documentation (i.e., accurate, current and complete)?

Contractor’s ability to solve contract performance problems without extensive guidance from counterparts?

Contractor’s ability to supply professional and qualified personnel?

Contractor’s ability to respond to emergency situations to include staffing and responsiveness?

TIMELINESS OF PERFORMANCE

Contractor’s ability to deliver all deliverables on time in accordance with contracted dates?

Contractor’s ability to perform all services within required timeframe?

Contractor’s ability to respond to urgent requests?

TEAMING ARRANGEMENTS

Contractor’s ability to provide an effective partnership with its team members?

What percentage of the contract award work was performed by the team members? (Provide Percentage)

Did the Prime contractor execute a teaming arrangement?

(Circle Y or N)

GENERAL TOPICS

Did the contractor comply with 508 requirements?

(when applicable)

1. Has this contract been partially or completely terminated for default? YES NO

If yes, please explain (e.g. inability to meet cost, performance, or delivery schedules - also include contract number, name, address, and phone number of Terminating Contracting Officer - TCO).

2. What was the contractor’s greatest strength in the performance of the contract?

3. What was the contractor’s greatest weakness in the performance of the contract?

4. Would you award another contract to this contractor? YES No

COMMENTS:

PART THREE: EVALUATOR’S CERTIFICATION

I HEREBY CERTIFY THAT THE INFORMATION IN THIS FORM IS ACCURATE AND COMPLETE TO THE

BEST OF MY KNOWLEDGE.

SIGNATURE OF EVALUATOR

TITLE OF EVALUATOR DATE