Attachment_2_HSCG84-15-R-1SA099__Request_for_Proposal_Attachment_2_PAST_PERFORMANCE_QUESTIONNAIRE__amendment_0003.doc

PAST PERFORMANCE QUESTIONNAIRE

U.S. COAST GUARD

Shore Infrastructure Logistics Center, Det.West

Air Traffic Control, Weather Observation and Augmentation Services

SOLICITATION NUMBER: HSCG84-15-R-1SA099

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 Air Traffic Control, Weather Observation and Augmentation Services. Please return completed survey to:

US Coast Guard, Air Station Cape Cod

Building 5215 E. Hospital Road

Attention: Jennifer Souza-Madura, Contracts

Buzzards Bay, MA 02542 Or to Jennifer.B.Souza-Madura@uscg.mil or fax 508-968-6640/6524.

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. VERY GOOD: Performance meets contractual requirements and may exceed these requirements to the Government’s benefit. 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.

3. SATISFACTORY: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

2. MARGIONAL: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a series problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

1. UNSATISFACTORY: - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element of sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

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