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U.S. DEPARTMENT OF HOMELAND SECURITY
U.S. COAST GUARD
SURFACE FORCE LOGISTIC CENTER (SFLC), CPD-2 IBCTPL
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 sends 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 Kathryn.e.stark@uscg.mil or (2) E-mail to Rebecca.l.koger Attn: CPD-2 IBCTPL
Please contact the Contract Officer, Kathryn.e.stark, at (757) 628-4588 if you have any questions.
The completed PPQ is due on or before March 24, 2016 1:00 PM Eastern.
II. GENERAL INFORMATION
| A. | PAST PERFORMANCE EVALUATOR & ORGANIZATION/COMPANY INFORMATION |
| 1 |
| Your Name: |
Company Name:
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: |
| 12 |
| Initial Contract Dollar Value (w/Options): |
| 13 |
| Final Contract Dollar Value (w/Options): |
| 14 |
| Period of Performance: |
| 15 |
| Place(s) of Performance: |
(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):
Past Performance Quality Ratings
| Exceptional |
| Performance met contractual requirements and exceeded many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective. |
| Very Good |
| Performance meets contractual requirements and exceeds many to the Government's benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly 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. |
| Neutral |
| The offeror has no past performance history OR the Contracting Officer has determined that the past performance information provided is not directly related or similar to the requirements in the RFQ. |
IV. EVALUATION: Rate the contractor in each of the following Evaluation Areas.
| 1. |
| Quality of Product or Service – please rate |
Comments:
| 2. |
| Schedule - Timeliness of Performance – please rate |
Comments:
| 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.”