Attachment_4_-_Past_Performance_Questionnaire_HSCG23-16-R-ANS028.doc

PAST PERFORMANCE QUESTIONAIRE

FOR SOLICITATION HSCG2316-R-ANS028

CONTRACT INFORMATION:

A. Contractor: _________________________

B. Contractor Address: ___________________

C. Contract Number: _______________________ Status: Active _____ Completed _____

D. Contract Amount: $______________

E. Period of Performance: ______________________

F. Services Provided (Explain in detail the type of services provided by the contractor):

RESPONDENT IDENTIFICATION (***NOT TO BE RELEASED OUTSIDE GOVERNMENT CHANNELS***)

A. Name: ________________________________________________

B. Position and Title: _______________________________________

C. Phone Number: _________________________________________

D. Address: _______________________________________________

E. Length of time your firm has been involved with the offeror: _____________________

F. Date questionnaire was completed: ________________________________

SUBMIT PAST PERFORMANCE COVER SHEET AND

QUESTIONNAIRE BY PROPOSAL DUE DATE TO:

Contract Specialist - Benjamin Simmons – Benjamin.simmons@uscg.mil

RATING SCALE

1. In this section of the questionnaire you are asked to rate the offeror. If you are unable to rate an item because it was not a requirement, never an issue, or you have no knowledge of the item in question, then you should mark “NA”. If you wish to elaborate on any of your answers, please provide comments at the end of this section.

2. ONCE COMPLETED, THIS SURVEY WILL BE CONSIDERED SOURCE SELECTION SENSITIVE IN ACCORDANCE WITH FAR PART 3.104.

3. The following definitions are applicable rating levels for the contractor’s performance:

Excellent -

The offeror’s performance was consistently superior. The contractual performance was accomplished with only minor problems for which corrective action taken by the contractor was highly effective.

Good -

The offeror’s performance was better than average, and you would willingly do business with the offeror again. The contractual performance was accomplished with minor problems for which corrective actions taken by the contractor were effective.

Neutral -

No record exists.

Average -

The offeror’s performance was satisfactory and consideration would take part in awarding a contract to the offeror again. The contractual performance reflects a problem for which the contractor has not yet implemented corrective actions.

Poor -

The offeror’s performance was entirely unsatisfactory and you would not do business with the offeror again under any circumstances. The contractual performance being assessed contains problems for which the contractor’s corrective actions appear to be or were ineffective.

NOTE:

For statements indicating “Poor”, please provide a brief explanation in the comments section of the survey.

CONTRACTOR PERFORMANCE EVALUATION SURVEY

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

(2) The Contractor submitted accurate reports.

(3) The Contractor utilized personnel that were appropriate to the effort performed.

b.) COST CONTROL:

(1) The Contractor performed the effort within the estimated cost/price.

(2) The Contractor submitted accurate invoices on a timely basis.

(3) The Contractor demonstrated cost efficiencies in performing the required effort.

c.) SCHEDULE:

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

(2) The Contractor was responsive to technical and/or contractual direction.

d.) BUSINESS RELATIONSHIPS:

(1) The Contractor demonstrated effective management over the effort performed.

(2) The Contractor maintained an open line of communication so that the

Contracting Officer’s Representative (COR) was apprised of technical, cost, and schedule issues.

(3) The Contractor presented information and correspondence in a clear, concise, and businesslike manner.

(4) The Contractor promptly notified the COR and the Contracting Officer in a timely manner regarding urgent issues.

(5) The Contractor cooperated with the Government in providing flexible, proactive, and effective recommended solutions to critical program issues.

(6) The Contractor made timely award to, and demonstrated effective management of, its subcontractors.

(7) The Contractor demonstrated an effective small/small disadvantaged business subcontracting program.

e.) CUSTOMER SATISFACTION:

(1) The products/services provided adequately met the needs of the program.

(2) The Contractor was able to perform with minimal or no direction from the

COR.

(3) I am satisfied with the performance of the Contractor under this effort.

f.) KEY PERSONNEL:

(1) The labor turnover in key personnel labor categories was minimal and did not adversely affect Contractor performance.

(2) The Contractor proposed qualified personnel to fulfill the requirements of the contract.

COMMENTS: