Attachment_4_-_Past_Performance_Survey.doc

Attachment 4

Past Performance Evaluation Document

EVALUATION INSTRUCTIONS

This questionnaire will be used by the Contract Specialist to obtain past performance information from a reference listed in the Contractor’s quotation. PLEASE TYPE YOUR RESPONSES. Please provide your assessment of the Contractor’s level of past performance on the contract for which you are a reference. Mark (X) the appropriate block using the following rating guidelines. Please provide comments for each of the headings. A copy of the contract’s specifications document, e.g., Statement of Work or Performance Work Statement, may be substituted for the Contract Effort Description.

Submit completed Questionnaire by the RFP due date via e-mail to Deborah Culver: deborah.culver@uscg.mil.

Overall Past Performance Rating

Acceptable - Based on the Offeror’s relevant past performance record, the USCG has a reasonable expectation that the Offeror will successfully perform the required effort or the Offeror’s relevant past performance record is unknown.

Neutral - If an Offeror having no record of relevant past performance through the federal database or relevant past performance information is not available, the Offeror will receive a neutral rating

Unacceptable - Based on the Offeror’s relevant past performance record, the USCG has no reasonable expectation that the Offeror will successfully perform the required effort.

Contractor Being Evaluated:

Company/Agency Completing Questionnaire:

Contract Number:

Delivery Order/Task Order Number:

Contract Value ($):

Evaluator Point of Contact Information:

Length of Involvement with Contractor (must be within the past 3 years):

Project Title/Deliverable:

A.) QUALITY OF PRODUCT OR SERVICE:

TECHNICAL PERFORMANCE

COMMENTS:

B.) SCHEDULE:

SCHEDULE

COMMENTS:

C.) MANAGEMENT:

MANAGEMENT RESPONSIVENESS

COMMENTS:

STAFFING

COMMENTS:

PROGRAM AND OTHER MANAGEMENT

COMMENTS: