Attachment G3-PastPerformanceQuestionnaire.pdf

SOURCE SELECTION INFORMATION (FAR 3.104)

Please return via E-Mail or FAX to: U.S. Coast Guard, Jing Liu, Contracting Officer, at

Jing.Liu@uscg.mil or fax (510) 437-3014 no later than 18 March 2011. Thank you for your time.

U.S. COAST GUARD

PAST PERFORMANCE QUESTIONAIRE

Name of evaluated firm: _____________________

To Reference Organization: In accordance with the Government’s increased emphasis on past performance and experience as an evaluation factor, the U. S. Coast Guard is hereby requesting past performance and experience information on the above-listed firm that has listed you as a reference for the above Solicitation, which requires the successful offeror to perform personal property moving and storage services for the US Coast Guard

Alameda, California.

Please complete the following Questionnaire and e-mail or FAX to the Coast Guard only at the above address. Please do not send a copy to the firm requesting the information.

Thank you in advance for taking the time to complete this survey and returning it to the Coast

Guard promptly but no later than (solicitation closing) 5 pm March 18 th

2011 California Time.

CONTRACTOR PERFORMANCE QUESTIONNAIRE

A. IDENTIFICATION

1. Respondent Organization Name:

2. Address:

3. Phone Number: Fax Number: E-Mail:

4. Name & Title of Evaluator:

5. Contract/Subcontract Number:

6. Contract/Subcontract Amount (including all options):

7. Contract Type: FFP Cost Reimbursable Other (specify)

Competitive ( ) Noncompetitive ( )

8. Period of Performance (including options, if applicable)

9. Short descriptive title of the contract: _____________________________________________

B. ASSESSMENT

NOTE: When indicated please circle the appropriate score, and for scores below or above satisfactory, please provide detailed comments, citing specific examples.

1. Relevancy: Contract of similar type, service, and dollar value

a. Type of Services Provided:

b. Contract Total Dollar value:

2. Responsiveness: Promptness, reaction to suggestions

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

COMMENTS:

3. Timeliness.

Timeliness of Contractor’s performance/Adherence to schedules/Report Submittals:

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

4. Resource Availability: Adequate personnel, training, equipment, and supplies/materials

a. Contractor’s personnel were trained and possessed necessary expertise:

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

b. Adequacy of on-site supervision:

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

c. Adequacy of equipment/supplies provided:

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

5. Adequate Oversight:

a. Effectiveness of Quality Control Program

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

b. Management of subcontracts:

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

6. Consistency and Quality of Services:

a. Contractor compliance with Work Statement:

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

b. Overall quality of services provided:

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

7. Customer Satisfaction:

a. Overall customer satisfaction:

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

b. Recommend doing business with this contractor: Yes No

8. Adherence to safety and health standards:

Contractor complied with safety and health standards to protect personnel, Government or

Commercial resources:

Rating: E-Excellent VG-Very Good S-Satisfactory M-Marginal U-Unacceptable N/A-Not Applicable

9. Additional comments, if any:

END OF SURVEY