Past Performance Survey.doc

U.S. COAST GUARD

Shore Infrastructure Logistics Center, West

Housing and Grounds Maintenance

SOLICITATION NUMBER: HSCG84-11-R-PSC001

Name of firm being evaluated: _______________________________ The above contractor has identified you or your Agency (company) as a reference for past performance information for the above referenced solicitation. Please complete this survey, evaluating the contractor’s previous performance for providing Housing and Grounds Maintenance Services. Please return completed survey to:

US Coast Guard, SILC

Coast Guard Island, Bldg 54C

Alameda, CA 94501

Or to susan.b.lawson@uscg.mil or fax 510-437-3014.

It is requested that you complete the following information and provide your assessment.

( Thank you for your assistance in the Past Performance evaluation process.

Organization Name: ___________________________________________ Phone Number: _________________ Name & Title of Survey Respondent: ____________ Contract Number: __________________________________

Location of Work:______________________________________

Description of services performed: ____________________________________________________________________________________________________________________________________________________________ Evaluation Scoring Definitions:

5. EXCEPTIONAL: The offeror's past performance exceeded the requirements in a way beneficial to the Government with no deficiencies found in the rated area of performance. The contractor receives high praise and strong recommendations.

4. SATISFACTORY: Performance meets contractual requirements and may exceed these requirements to the Government’s benefit on occasion. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective. The contractor received an overall good appraisal and performed average services.

3. MARGINAL: The offeror's past performance indicates a failure to meet requirements of the contract. Several deficiencies were found during contract performance but the contractor cured these through close Government monitoring and special emphasis. Weaknesses are offset by some strengths.

2. UNSATISFACTORY: The offeror's past performance indicates they cannot meet the requirements of the current contract in many areas. Many deficiencies were not cured during contract performance. No evidence to indicate the contractor has resolved the problems that caused the defective performance. Performed services in a sub-average manner.

1. NEUTRAL: - Performance was not observed or not applicable to the current effort being reported against.

NOTE: When indicated please circle the appropriate number associated with the above adjective, for ratings below satisfactory, please comment.

1. Relevant Experience: Contract of similar type and dollar value

a. Type of Contract: ____________________________

b. Dollar Value: $

c. Prime Contractor Y/N Sub-Contractor Y/N

d. Date of award and completion: __________________________

e. Amount of subcontracting: ___________________________

COMMENTS:

1.

Management Approach a.

Transition Plan/Start up of Contract:

b.

Resources: Adequate personnel, training, equipment, and supplies/materials.

Contractor’s number of personnel were adequate for successful contract performance:

5 4 3 2 1 n/a

Contractor’s personnel were trained and possessed expertise necessary for successful contract performance:

5 4 3 2 1 n/a

Contractor maintained adequate equipment supplies/material necessary for successful contract performance:

5 4 3 2 1 n/a

2.

Ability to adhere to schedules.

a Timeliness: Services performed timely

3.

Quality of work, performance in accordance with contract requirements.

a.

Consistency and Quality of Services:

Description of any environmental or safety violations which occurred during performance of the contract and, if applicable, what actions were taken to prevent future recurrence of these violations.

b.

Documentation:

4.

Business Relations.

a.

Government Oversight:

Receptive to the government’s suggestions:

5 4 3 2 1 n/a

10. Additional Comments:

5.

Customer satisfaction.

a.

Competence / Customer Satisfaction:

Options not exercised due to poor performance:

If yes, please insert comment below.

Yes No

1) Contract Discrepancy Reports issued:

2) Discrepancies were corrected satisfactorily:

If no, please insert comment below.

Yes No

Yes No No

Problems encountered and corrective action taken