Corrected_Past_Performance_Survey.doc

For official use only

Source Selection information

RETURN FAX TO:

Contracting Specialist (Pcb-4), Emely Hagins, e-mail: Emely.Hagins@uscg.mil Telephone: 510-437-3057 3 PAGES, NO COVER SHEET

U.S. COAST GUARD

SHORE INFRASTRUCTURE LOGISTICS CENTER (SILC)

PAST PERFORMANCE SURVEY

Solicitation Number: HSCG89-13-R-B13029

(NAME OF FIRM)

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 performance under your contract. The Performance Work Statement requires the successful offeror to provide overhaul and outfitting of Aids to Navigation (A/N) Buoys at U.S. Coast Guard 13th District, Washington and Oregon areas during the period 01 July 2013 through 30 June 2014, with four one year options, if exercised. The successful offeror is required to provide all labor, tools, equipment, materials and supervision, and shall plan, schedule, coordinate and ensure effective and economical completion of all work and services.

Please complete the following information and provide your assessment NLT 30 January 2013 directly to Ms. Emely Hagins, Contracting Specialist at Emely.Hagins@uscg.mil.

Organization Name:

Address:

Phone Number:

E-Mail:

Name & Title of Evaluator:

Contract Number:

Contract Type

Competitive ( ) Noncompetitive ( )

Period of Performance Including Option Years

NOTE: FOR SCORES BELOW SATISFACTORY – PLEASE INSERT COMMENT

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

a. Type of Services Provided:

b. Contract Total Dollar value:

COMMENTS:

2. Responsiveness: Promptness, reaction to suggestions

a. Contractor promptness reacting to suggestions:

Rating: Excellent Satisfactory Marginal Unacceptable N/A Not Applicable

3. Timeliness: Services performed timely

a. Timeliness of Contractor’s performance:

b. Extent of Contractor’s adherence to schedules:

c. Accuracy, completeness and timeliness of reports and documentation:

d. Liquidated damages assessed, or deductions taken for late or nonperformance of services:

Yes No If yes, please insert comment below.

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

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

b. Adequacy of On-site supervisor’s authority:

c. Adequacy of equipment/supplies provided:

5. Adequate Oversight:

a. Effectiveness of Quality Control Program:

6. Quality of Services:

a. Contractor compliance with Work Statement:

b. Overall quality of services provided:

c. Contractor performance without repeated attempts to perform work correctly:

d. Management responded to problems and concerns, taking action to ensure no repeat occurrences:

e. Rating: Excellent Satisfactory Marginal Unacceptable N/A Not Applicable

7. Customer Satisfaction:

a. Overall customer satisfaction:

b. Options not exercised due to poor performance:

Yes No If yes, please insert comment below.

c. 1) Contract Discrepancy Reports issued:

Yes

2.) Discrepancies were corrected satisfactorily:

If no, please insert comment below.

d. Recommend doing business with this contractor:

8. Adherence to safety and health standards.

a. Contractor complied with safety and health standards to protect personnel, Government or Commercial resources:

END OF SURVEY

Attachment 1