Attachment 2 - Past Performance Questionnaire

Solicitation: HSCG84-12-Q-AAS217 Attachment 2 – Past Performance Questionnaire

U.S. DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

SHORE INFRASTRUCTURE LOGISTICS CENTER (SILC), PCB-4

300 EAST MAIN STREET, SUITE 965

NORFOLK, VA 23510-9112

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

In order to assess potential vendors, the U.S. Coast Guard, Shore Infrastructure Logistics Center (SILC) contracting office is obtaining past performance information with respect to each vendor. The potential vendor has identified you as a reference to validate the vendor’s past performance. This PPQ must be completed by the Past Performance Reference (i.e., you), NOT the Vendor, and submitted directly to the USCG by the Past Performance Reference. DO NOT release the completed PPQ to the vendor. In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information.

We are thanking you in advance for your time, effort, and cooperation in responding to this questionnaire.

Please submit the completed form to the Contract Specialist via one of the following methods: (1) E-mail to Christina.M.Grimstead@uscg.mil or (2) Fax to (757) 628-4135, Attn: PCB-4. Please contact the Contract Specialist, Christina Grimstead, at (757) 628-4116 if you have any questions. The completed PPQ is due on or before December 28, 2011 3:00 PM Eastern, unless extended via a Solicitation Amendment.

I. GENERAL INFORMATION

A. PAST PERFORMANCE REFERENCE & ORGANIZATION/AGENCY IDENTIFICATION

1 Your Name:

2 Your Title:

3 Organization/Agency/ Company Name:

4 Address:

5 Phone Number:

6 Fax Number:

7 E-mail Address:

8 Date:

9 Your Signature:

B. VENDOR/CONTRACTOR NAME & CONTRACT IDENTIFICATION

1 Name of Vendor/Contractor being evaluated:

2 Type of Instrument (e.g., Contract/BPA/Order/Other):

“Source Selection Information—See FAR 2.101 and 3.104.”

Solicitation: HSCG84-12-Q-AAS217 Attachment 2 – Past Performance Questionnaire

3 Contract or Reference Number:

4 Order Number (if applicable):

5 Service/Supply Description:

6 Type of Contract (e.g., Negotiated, Sealed Bid):

7 Pricing Type (e.g., Fixed Price, T&M, Cost Reimbursement, other):

8 Competitive (Y/N):

9 Follow-On (Y/N):

10 Date of Award:

11 Initial Contract Dollar Value (w/Options):

12 Final Contract Dollar Value (w/Options):

13 Period of Performance:

14 Place(s) of Performance:

15 Complexity of Work (e.g. difficult, routine):

16 If applicable , type and extent of subcontracting (add rows if needed):

C. OTHER INFORMATION

1 Has the Vendor/Contractor ever been given a cure notice, show cause notice, suspension of progress payments, etc.? If yes, explain. No / Yes

2 Has the contract been partially or completely terminated? If yes, explain and identify type of termination (e.g., default, convenience, cause). No / Yes

Solicitation: HSCG84-12-Q-AAS217 Attachment 2 – Past Performance Questionnaire

3 If this was an award or incentive fee contract, what percentage of the available fee did the Vendor/Contractor usually receive?

Changes in contract dollar amounts throughout the life of the contract are/were generally attributable to customer-issued Change Orders, Contractor-submitted claims, or other Customer actions (please explain):

II. GENERAL GUIDANCE

Please use the following ratings to score the performance elements below (assessments should reflect only vendor/contractor-liable performance):

RATING DESCRIPTION

Exceeds Performance far exceeded the customer's expectations and provided significant, unusual worthwhile features or benefits.

Satisfactory Performance met the customer's expectations and contract requirements.

Marginal Performance could have been improved. The Vendor/Contractor required major agency resources to ensure achievement of contract requirements.

Unsatisfactory Performance did not meet customer expectations and/or contract requirements.

III. EVALUATION: How Would You Rate This Vendor/Contractor With Respect To:

A. Compliance with the Statement of Work (SOW), specifications and/or requirement; conformance to standards of good workmanship, and responsiveness to technical direction:

Rating Exceeds Satisfactory Marginal Unsatisfactory Check √

Summary:

B. Adherence to the contract delivery schedule (completing work on time):

Solicitation: HSCG84-12-Q-AAS217 Attachment 2 – Past Performance Questionnaire

“Source Selection Information—See FAR 2.101 and 3.104.”

C. Adherence to contract/task order estimates; reasonableness of change order proposals; and completeness of billing:

D. Working relationship with Contracting Officer, Contract Specialist, COTR, customer, and/or other points of contact:

E. Relationship with and satisfaction level of organization/agency/company end-user of product or service (customer satisfaction):

IV. SUMMARY

Would your agency/organization/company award another contract to this Contractor (or use the services of the Vendor/Contractor again)? Yes / No

In summary, if you care to, please give your overall assessment of this Vendor/Contractor.

Do you have any additional comments to add?