2_-_Past_Performance_Questionnaire_SHUTTLE_SVCS.doc

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Past Performance Questionnaire - New submittal date

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Solicitation: HSCG84-16-Q-B11096 Attachment 2 – Past Performance Questionnaire

U.S. DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

SILC-COCO-BSS-COB4

Coast Guard Island, Bldg. 54-C

ALAMEDA, CA 94501-5100

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

I. INSTRUCTIONS

The company (i.e., contractor) that sent you this questionnaire intends to submit an offer in response to a U.S. Coast Guard solicitation for shuttle services between Coast Guard Island, Alameda, California and the Ronald V. Dellums Federal Building, Oakland, California and has identified you as a reference to validate their performance. This PPQ must be completed by the person most familiar with the contractors’ performance on a present or previous contract and then submitted directly to the U.S. Coast Guard by the person completing the PPQ. Please DO NOT send the completed PPQ to the contractor being evaluated. 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 Emely.Hagins@uscg.mil or (2) Fax to (510) 437-3057, Attn: SILC-COCO-BSS-COB4. If method 2 is selected, please contact the contract specialist prior to sending.

Please contact the Contract Specialist, Emely Hagins, at (510) 437-3057 if you have any questions.

The completed PPQ is due on or before 21 October 2016; 2:30 PM Pacific extended via a Solicitation Amendment 00004.

II. GENERAL INFORMATION

A.

PAST PERFORMANCE EVALUATOR & ORGANIZATION/COMPANY INFORMATION

1
Your Name:
2
Your Title:
3
Your Organization/

Company Name:

4
Address:
5
Your Phone Number:
6
Your Fax Number:
7
Your E-mail Address:
8
Date:
9
Your Signature:

B.

CONTRACTOR NAME & CONTRACT IDENTIFICATION

1
Name of Contractor being evaluated:
2
Type of Instrument (e.g., Contract, Purchase Order, Task Order, Other):
3
Pricing Type (e.g., Fixed Price, Time & Material, Cost Reimbursement, Other):
4
Contract or Reference Number:
5
Subcontract Number (if applicable):
6
Order Number (if applicable):
7
Role of Contractor listed in #1 above

(if sub, also provide name of prime)

FORMCHECKBOX

Prime Contractor

FORMCHECKBOX

Subcontractor (Prime is_______________________________)

8
Description of Service/Supply:
9
Competitive (Y/N):
10
Follow-On (Y/N):
11
Date of Award:
12
Initial Contract Dollar Value (w/Options):
13
Final Contract Dollar Value (w/Options):
14
Period of Performance:
15
Place(s) of Performance:
16
Complexity of Work

(e.g., difficult, routine):

17
If applicable , type and extent of subcontracting:

III. GENERAL GUIDANCE

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

RATING
DESCRIPTION
Exceptional
Performance meets contractual requirements and exceeds many to your organization’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
Very Good
Performance meets contractual requirements and exceeds some to your organization’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
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.
Marginal
Performance does not meet some contractual requirements. The contractual performance of the evaluation area being evaluated reflects a serious 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.
Unsatisfactory
Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the evaluation area being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

IV. EVALUATION: Rate the contractor in each of the following Evaluation Areas.

A. Quality of Service. Assess the contractor’s conformance to contract requirements (e.g., specified technical, professional, environmental, or safety and health standards). List and assess any sub-elements to indicate different efforts where appropriate. For example: Does the service provided meet the specifications of the contract? Does the contractor’s work measure up to commonly acceptable technical or professional standards? What degree of Government technical direction was required to solve problems that may have arose during performance, if any?

RATING
Exceptional
Very Good
Satisfactory
Marginal
Unsatisfactory
N/A

Check (

Comment(s):

B. Schedule. Assess the timeliness of the contractor against the completion of the contract, task orders, milestones schedules, and administrative requirements (e.g., efforts that contribute to or affect the schedule variance). For example: Is the Contractor meeting all scheduled routes in a timely manner? Did the Contractor adequately schedule the bus routes to meet the desired schedule/locations? How did the contractor respond to accidents, interruptions, or heavy traffic? Has the Contractor met physical milestone dates specified by the contract, or agreed to, in the project schedule? If the schedule has slipped through as a result of the Contractor’s fault or negligence, has the Contractor taken appropriate corrective action of its own decision? Has the Contractor furnish all required deliverables on or ahead of schedule? Did the Contractor perform unscheduled shuttle services if any, in a timely fashion?

RATING
Exceptional
Very Good
Satisfactory
Marginal
Unsatisfactory
N/A

Check (

Comment(s):

C. Cost Control. Assess the contractor’s effectiveness in forecasting, managing, and controlling contract or order cost. For example: Does the contractor keep within the total cost? Did the contractor do anything innovative that resulted in a cost savings? (e.g., better route using less fuel) Were billings current, accurate and complete? Are the contractor’s budgetary internal controls adequate? Has the Contractor notified the Government and taken necessary corrective actions when the cost estimate exceeds available funds?

RATING
Exceptional
Very Good
Satisfactory
Marginal
Unsatisfactory
N/A

Check (

Comment(s):

D. Management. Assess the integration and coordination of all activity needed to execute the contract, specifically the timeliness, completeness and quality of problem identification, corrective action plans, proposal submittals, the contractor’s history of reasonable and cooperative behavior (to include timely identification and resolution of issues in controversy), customer satisfaction, timely award and management of subcontracts. Is the contractor oriented toward the customer? Is interaction between the contractor and your organization satisfactory, or does it need improvement? Assess the contractor’s performance in selecting, retaining, supporting, and replacing, necessary, personnel. For example, how well did the contractor match the qualifications of the key position, as described in the contract, with the person who filled the key position? Drivers: Were adequate drivers provided who possessed the necessary licensing and experience to drive a shuttle bus/bus. Did the contractor support their personnel so they were able to work effectively? If a key person or employee did not perform well, what action was taken by the contractor to correct this? If a replacement of a key person or driver was necessary, did the replacement meet or exceed the qualifications of the position as described in the contract schedule?

RATING
Exceptional
Very Good
Satisfactory
Marginal
Unsatisfactory
N/A

Check (

Comment(s):

E. Regulatory. Assess compliance with all terms and conditions in the contract or order relating to applicable regulations, licensing, and codes. Consider aspects of performance such as compliance with financial, environmental (example: Clean Air Act, Clean Water Act), safety, and labor regulations, as well as any other reporting requirements in the contract.

RATING
Exceptional
Very Good
Satisfactory
Marginal
Unsatisfactory
N/A

Check (

Comment(s):

V. SUMMARY

Would your organization/company award another contract to this Contractor (or use the services of the Contractor again)? FORMCHECKBOX Yes / FORMCHECKBOX No In summary, if you care to, please give your overall assessment of this Contractor.

Do you have any additional comments to add?

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

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