Att_E_PXC002_Past_Performance.docx

Relevant Past Performance Questionnaire for

HSCG23-16-R-PXC002

Please complete the following questionnaire, scan and email it to the attention of Contract Specialist Katherine West at Katherine.K.West@uscg.mil and Contracting Officer Richard.J.Murphy@uscg.mil no later than two business days after the proposal due date. Please email Ms. West if you have any questions..

SECTION A: Offeror is to complete this section of the questionnaire for each past performance reference and forward the survey to their past performance reference for completion of SECTION B. The Past Performance reference is to send the completed questionnaire to the Contract Specialist in accordance to the instructions above.

Name of Company being evaluated: ____________________________________________________________

Name of Company Completing Survey: (Past Performance Reference)

Name and Title of Person Completing Survey: (Past Performance Reference)

Signature of Person Completing Survey: _________________________________________Date:__________

Phone Number: _______________________ E-mail: ____________________________________________

Contract Number: _________________________________________________________________________

Period of Performance of Evaluation: __________________________________________________________

Contract/Task Order Total Price: _____________________________________________________________

Cite any certifications achieved relevant to the operation of simulators (i.e. DNV Class A FMSS, STCW, Etc.).

Certifications:_____________________________________________________________________________

Indicate the training the relevant simulator(s) are certified to provide (i.e. STCW/USCG Bridge Resource Management, ECDIS, Etc.).

Certifications for Training: ___________________________________________________________________

General description of products/services required under the contract (This is required in order for a determination to be made that the services provided are relevant:

SECTION B: The past performance reference is to complete the information below indicating the offeror performance on the contract cited on page one. Please input the offeror name in the top row of the table (company being evaluated).

PLEASE CHECK THE APPROPRATIATE RATING

OFFEROR NAME _Insert Name of Company being evaluated here_

1. Compliance with Contract Requirements

2. Effectiveness of Personnel

3. Technical Approach

4. Record of conforming to specifications

5. Accuracy of Technical Reports

Quality of Service Narrative:

Timeliness of Performance

1. Reliability

2. Responsiveness to technical direction

3. Met delivery schedule

4. Completed on time including wrap up

Timeliness of Performance Narrative:

Business Relations

1. Responsive to Contract requirements

2. Prompt Notification of Problems

3. Commitment to customer satisfaction

4. Would you recommend selection of this firm again?

Business Relations Narrative:

Any additional comments:

PAST PERFORMANCE RATING

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

Commentary to support very high or very low rating should be noted on the narrative row for each section.

The Government will assess an overall past performance rating for each survey provided. The ratings for all surveys received for an offeror will then be combined to arrive at a final past performance rating based upon the following rating scheme:

RATINGS ARE DEFINED AS FOLLOWS:

Definition Description

1 of 3 Past Performance Questionnaire Attachment E