Attachment_3_Past_Performance_Questionaire.pdf

RFP HSCG84-16-R-AA9485

ATTACHMENT 3

U.S. COAST GUARD

SHORE INFRASTRUCTURE LOGISTICS CENTER

CONTRACTOR EVALUATION FORM

The Coast Guard, Shore Infrastructure Logistics Center (SILC), is currently procuring Buoy

Overhaul/Maintenance Services for U.S. Coast Guard District 9. As a result, we are performing a survey and reference investigation on possible contractors for the upcoming contract.

The information contained herein is considered “Source Selection Information” in accordance with

FAR 3.104. Therefore, it is asked that you treat it accordingly. While the results of the overall past performance survey may be discussed with the contractor, FAR Part 15.610 and 15.1004 prohibits the release of the name of the individual responding to the survey.

Responses to this questionnaire should be EMAILED TO MS. JILLIAN NOBLETT AT

Jillian.L.Noblett@uscg.mil.

Should you have any questions concerning this survey, please contact the above named person at (757)

628-4113

I. CONTRACT IDENTIFICATION

Nam of Contractor Being Rated:

Contract Number:

Contract Type:

Period of Performance:

Type of Service Provided:

Respondent’s Name:

Phone:

E-Mail

Fax:

Respondent’s Company/Agency Name:

II. GENERAL GUIDANCE:

The following questions are divided into two types: YES/NO and RATING. When responding to the

RATING type questions, choose the rating on the scale of Exceptional to Unsatisfactory, which most accurately describes the contractor’s performance or situation. Responses to the RATING type questions may be supplemented with an explanatory narrative as well. Please assign an overall rating for each section where indicated.

mailto:Jillian.L.Noblett@uscg.mil

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION

SEE FAR 3.104

Please rate the contractor on a graduated scale from Exceptional to Unsatisfactory in accordance with the following descriptive values:

Rating Description

Exceptional Performance meets contractual requirements and exceeds to your company’s benefit. The element being assessed 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 company’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory Performance meets contractual requirements. The element being assessed 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 element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.

Unsatisfactory Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

IF AN ELEMENT IS NOT APPLICABLE TO YOUR SERVICES, PLEASE RATE AS N/A.

III. QUALITY OF SERVICE: RATING

1. The contractor’s level of effort regarding acquired services met your requirements.

2. The contractor’s initiative at correcting problems or deficiencies prior to

Government intervention.

3. The contractor’s response to emergencies

4. Contractor’s overall quality of service

5. Has a contract discrepancy report (or equivalent) ever been issued? Yes ___No ___

6. Has an election ever been made to not exercise an option due to contractor’s poor performance?

Yes ___No ___

OVERALL RATING FOR QUALITY OF SERVICES

COMMENTS: ___________________________________________________________________

CUSTOMER SATISFACTION:

1. Rating for customer satisfaction

2. Ability of the contractor to meet the terms of the contract

OVERALL RATING FOR CUSTOMER SATISFACTION

COMMENTS: __________________________________________________________________

C. MANAGEMENT/LABOR:

1. Performance of on-site management staff.

2. Performance of labor force.

3. Corporate management’s support of contract performance.

4. Have there been any labor disputes or violations of the Service Contract Act? Yes ___No ___

OVERALL RATING FOR MANAGEMENT/LABOR

COMMENTS: __________________________________________________________________

V. GENERAL/BUSINESS RELATIONS:

1. Contractor’s preparation and training of personnel.

2. Contractor’s compliance with contractual terms and conditions.

3. Contractor’s ability to meet the terms of the contract within the contractually agreed price.

4. Contractor’s overall cooperation relative to this contract

5. Have there been any indications that the contractor has had any financial problems?

6. Have there been any disputes/claims relative to this contract?

7. Willingness to award another contract to this contractor.

OVERALL RATING FOR GENERAL/BUSINESS RELATIONS

COMMENTS: _________________________________________________________________

ADDITIONAL COMMENTS ON ANY RATING ELEMENT CAN BE MADE BELOW: