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ATTACHMENT #5: PAST PERFORMANCE QUESTIONNAIRE
U.S. DEPARTMENT OF HOMELAND SECURITY
U.S. COAST GUARD
SURFACE FORCE LOGISTIC CENTER (SFLC), CPD-2 IBCT
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 thank you in advance for your time, effort, and cooperation in responding to this questionnaire.
Please submit the completed form to the Contract Specialists noted below via one of the following methods: email to: Iran.N.Walker@uscg.mil and Sandra.A.Martinez@uscg.mil ; or facsimile to (757) 628-4628, Attn: CPD-2 IBCT.
Please contact Iran Walker at (757) 628-4563, or Sandra Martinez at (757) 628-4591, the Contract Officer, if you have any questions.
The completed PPQ for Solicitation: HSCG85-17-Q-P45F55 USCGC HAWSER (WYTL 65610) DRYDOCK on or before 23 June 2017 at 1:00 PM Eastern Standard Time (EST).
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):
| 0 = Unsatisfactory |
| Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective. |
| 1 = Marginal |
| Performance does not meet some contractual requirements. The contractual performance element 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. |
| 2 = Satisfactory |
| Performance meets contractual requirements. The contractual performance element 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 contractual performance element being 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 contractual performance of the element being evaluated 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.
| 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.”