Attachment D.doc
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- Solicitation number
- HSCG44-10-R-TEDSSA
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Attachment (D)
PAST PERFORMANCE QUESTIONNAIRE
Your assistance is requested in support of a source selection for Solicitation HSCG44-10-R-TEDSSA.
Please complete this Questionnaire and mail or send email to:
Gwendolyn Scott Contracting Officer C2CEN
4000 Coast Guard Blvd Portsmouth VA 23703-2199 Gwendolyn.B.Scott@uscg.mil
Response Date:__________________ (MM, DD, YYYY)
When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.
TO BE COMPLETED BY OFFEROR
1. CONTRACTOR NAME & ADDRESS:
2. CONTRACT NO.:
3. CONTRACT INITIATION DATE:
4. COMPLETION DATE:
5. CONTRACT VALUE (with options):
7. REFERENCE #:
6. TYPE OF CONTRACT:
8. DESCRIPTION OF CONTRACT REQUIREMENTS:
Please use continuation pages if additional space is needed.
TO BE COMPLETED BY EVALUATING ORGANIZATION’S REPRESENTATIVE
9. EVALUATOR:
a. NAME:_____________________________________ POSITION:______________________________ ORGANIZATION:_____________________________
b. EVALUATOR'S PHONE NUMBER:________________________ c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:_________________
Please underline the response code for each topic (1-11) that best reflects your experience with this contractor. SU and US require comments
| SU = Superior |
| S = Satisfactory |
| MG = Marginal |
| US = Unsatisfactory |
| N/O = Neutral |
1. Competence and skill level of the technical staff?
SU
S
MG
US
N/O
2. System Development Life Cycle performance?
MG
US
3. Soundness of business model and technical approach
MG
US
4. Successful identification and implementation of new technologies and processes?
MG
US
5. Competence of management staff?
MG
US
6. Soundness of management business model?
MG
US
| EX = Exceptional |
| VG = Very Good |
| S = Satisfactory |
| MG = Marginal |
| US = Unsatisfactory |
| N/O = Not Observed |
7. Recruitment and retention of qualified staff?
MG
US
8. Cost accountability and accuracy of cost reporting?
MG
US
9. Soundness and success of teaming arrangements?
MG
US
10. Training of staff?
MG
US
11. Cooperation & teamwork with customer?
MG
US
Comments: As required to provide additional information/clarification. Mandatory for all topics with SU or US
Comments: As required to provide additional information/clarification. (CONTINUED)
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