PASTPERFQUEST-07R20017.doc

HSCG40-07-R-20017

Attachment (I)

Past Performance Questionnaire

Purpose: The U.S. Coast Guard has a requirement for various Buoy Hardware Parts to be manufactured in accordance with various Coast Guard Specifications all dated October 2006 and associated Coast Guard drawings which form a part of the solicitation requirements. This questionnaire is to be used by the Contract Specialist to obtain past performance information from a reference listed in an Offeror’s proposal. The results of the questionnaire will be afforded to each member of the Technical Evaluation Team for consideration in the evaluation of the past performance sub-factor.

Your company name

Product Description

Point of Contact

Contract No.

Delivery Order No.

Contracting Officer/Buyer

Contractor Name

Your E-Mail Address Phone/fax number

Date:

Questions

1. To what extent did the contractor adhere to the contract/delivery order schedule?

Considerably surpassed/exceeded delivery schedules [ ] Met delivery schedule (no excusable delays) [ ] Minimal delay (did not impact achievement of contract requirements) [ ] Extensive unexcused delays [ ]

Comments:

Past Performance Questionnaire

2. To what extent was the contractor able to solve contract performance problems without extensive guidance from your company?

Completely successful [ ] Generally successful [ ] Little success [ ] No success [ ]

3. To what extend did the contractor display initiative in meeting requirements?

Displayed considerable initiative [ ] Displayed some initiative [ ] Displayed little initiative [ ] Displayed no initiative [ ]

4. Has the contract been partially or completely terminated for default?

[ ] YES

] ] NO

If yes, briefly explain (i.e. inability to meet performance or delivery schedules)

5. Provide an overall rating of the contractor’s quality of the product supplied.

Excellent – conformed to contract/specification requirements [ ] Satisfactory – slight nonformance did not effect product [ ] Unsatisfactory – nonconformance inhibited product usefulness [ ] Poor – extensive nonconformance [ ]

If the contractor experienced extensive nonconformance, please explain below the circumstances surrounding nonconformance (i.e. inability to meet specification requirements).

Past Performance Questionnaire

6. Would you contract with the contractor again and would you refer this contractor to other potential sources?

YES [ ]

NO [ ]

7. Did the contractor manufacture the product?

YES [ ]

NO [ ]

If NO, please explain: