Attachment_2-Past_Performance_Questionnaire.pdf

Request for Proposal: HSCG84-13-R-BB8031 Attachment 2 – Past Performance Questionnaire

Appendix 3

DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

SHORE INFRASTRUCTURE LOGISTICS CENTER (SILC), PCB-4

300 EAST MAIN STREET, SUITE 965

NORFOLK, VA 23510-9113

SOLICITATION: HSCG84-13-R-BB8031

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

In order to assess potential vendors, the Shore Infrastructure Logistics Center (SILC) contracting office is obtaining past performance information with respect to each offeror. This PPQ must be completed by the

Past Performance Reference, NOT the Offeror, and submitted directly to USCG SILC (pcb-4) by the Past Performance Reference. The completed PPQ shall not be released to the offeror. 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 Amy McLiverty, Contract Specialist via one of the following: (1) Email to amy.l.mcliverty@uscg.mil (preferred method) (2) Fax to (757) 628-4135, Attn: PCB-4. Please contact the

Contract Specialist, Amy McLiverty, at (757) 628-4483 if you have any questions. The completed PPQ is due on or before December 12, 2012 at 3:00 PM, EST.

I. GENERAL GUIDANCE

Please use the following rating in scoring the performance elements below (assessments should reflect only contractor-liable performance):

RATING DESCRIPTION

Exceeds The Contractor's past performance far exceeds the customer's expectations and provided significant, unusual worthwhile features or benefits.

Satisfactory The Contractor's past performance met the customer's expectations and contract requirements

Marginal The Contractor's past performance could have been improved. The Contractor required major agency resources to ensure achievement of contract requirements.

Unsatisfactory The Contractor's past performance did not meet customer expectations and/or contract requirements.

II. GENERAL INFORMATION

A. AGENCY & RESPONDENT IDENTIFICATION:

1 Name:

2 Title:

3 Organization:

4 Address:

5 Phone Number:

6 Fax Number:

mailto:amy.l.mcliverty@uscg.mil

7 E-mail Address:

8 Date:

9 Signature:

B. CONTRACT IDENTIFICATION:

1 Name of Contractor:

Type of Instrument

(e.g. Contract/BPA/Order/Other):

2 Contract Identification Number:

3 Order Number (If applicable):

Project Title and Service Description (Add rows if needed): Include Number of Rooms provided and on what basis (daily, weekly, monthly, etc)

Type of Contract

(e.g. Negotiated, Sealed Bid):

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

7 Date of Award:

8 Contract Dollar Value/Ceiling:

9 Period of Performance:

10 Place(s) of Performance:

C. GENERAL INFORMATION

Has this Contractor ever failed to provide services required by the contract? If yes, explain.

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

A. Compliance with the SOW and specifications; 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:

C. Working relationship with Contracting Officer, COTR, and other points of contact:

In summary, if you care to, please give your overall assessment of this contractor.

Do you have additional comments to add?