PAST PERFORMANCE QUESTIONNAIRE for 270's.doc

PAST PERFORMANCE QUESTIONNAIRE

The U. S. Coast Guard Surface Forces Logistics Center Contracting Office, Baltimore, MD is conducting a competitive acquisition. The offeror has identified you as a reference to validate the offeror’s past performance.

Please complete this questionnaire to assist our evaluation of the contractor’s past performance and scan and email to: Martine.M.Duvall@uscg.mil, or fax it to (410) 762-6306.

Your Name and Phone No:______________________________________ Organization/Agency/Company Name:_____________________________ Name of Contractor being evaluated:______________________________ Contract No:__________________________________________________

Description of the Requirement (include the size, scope and complexity):

Total contract cost:_____________________________________________

1. What is the make and model number of the Oil Content Meter on which the contractor performed calibration and repair?

2. To what extent did the contractor adhere to contract delivery schedules?

Considerably surpassed/exceeded delivery schedules

Met delivery schedule (no unexcusable delays) Minimal delays (did not impact achievement of contract requirements) [ ] Extensive unexcused delays

COMMMENTS:__________________________________________________________

3. To what extent was the contractor able to solve contract performance problems without extensive guidance from the government?

Completely successful [ ]

Generally successful [ ]

Little success [ ]

No success [ ]

4. To what extent did the contractor display initiative in meeting requirements?

Displayed considerable initiative [ ]

Displayed some initiative [ ]

Displayed little initiative [ ]

Displayed no initiative [ ]

5. Has the contract been partially or complete terminated for default?

[ ] YES

[ ] NO

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

6. Provide an overall rating of the quality of the services supplied by this contractor.

Excellent – conformed to contract/specification requirements [ ]

Satisfactory – slight nonconformances did not affect equipment [ ]

Unsatisfactory – nonconformance inhibited equipment usefulness [ ]

Poor – extensive nonconformances [ ]

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

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

[ ] YES

[ ] NO

If NO, please explain:_____________________________________________________