Past_Performance_Questionnaire.docx

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Attached to
HSCG85-16-C-P45664 SCIOTO DD REPAIRS Federal contract opportunity
Solicitation number
HSCG85-16-C-P45664
Issued by
Department of Homeland Security US Coast Guard

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PAST PERFORMANCE QUESTIONAIRE

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SCIOTO_(WLR_65B)_DD_FQ3_BMM_16R0_Specification.pdf PDF

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Solicitation: HSCG85-16-C-P45664

U.S. DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

SURFACE FORCE LOGISTIC CENTER (SFLC), CPD-1 PBPL

300 EAST MAIN STREET, SUITE 600

NORFOLK, VA 23510-9112

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 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 Crystal.g.Elliott@uscg.mil or (2) Fax to 757 628-4628 Attn: SFLC-CPD-C&P2-IBCT

Please contact the Contract Specialist, Crystal Elliott, at 757-270-8684 if you have any questions.

The completed PPQ is due on or before 26 February 2016, at 10:00AM Eastern.

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 (Prime or Sub)

(if sub, also provide name of prime)

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):

0 = 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.
1 = 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.
2 = 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.
3 = Very Good
Performance meets contractual requirements and exceeds some to the Governments benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
4 = Exceptional
Performance meets contractual requirements and exceeds many to the Governments benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

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

0
1
2
3
4
N/A
1.
Quality of Product or Service – please rate

Comments:

2.
Schedule - Timeliness of Performance – please rate

Comments:

0
1
2
3
4
N/A
3.
Cost Control – please rate

Comments:

4.
Business Relations – please rate

Comments:

5
Management of Key Personnel – please rate

Comments:

6
Utilization of Small Business

Comments:

Were Subcontractors Used? ____Yes _____No Comments for Subcontracts

V. SUMMARY

Would your organization/company award another contract to this Contractor (or use the services of the Contractor again)? |_| Yes / |_| 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.”

File details come from the government source that posted it. Updated .