2011 TMACCPast Performance Questionnaire.doc

Solicitation #HSCG88-11-R-TMACC

TMACC PAST PERFORMANCE SURVEY QUESTIONNAIRE

FOR OFFICIAL USED ONLY (When Filled In)

A.

GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name:

Address: _________________________ Telephone Number: ____________________

Fax Number:

Point of Contact:

Description of Scope of Work ____________________________________________________________________*

Contract Number Provided by Offeror: ___________________ Dollar Amount of Contract: ________________*

Contract Completion Date: ___________________________*

*Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

Contractor performed as the ( Prime Contractor ( Sub-Contractor ( Key Personnel.

B.

EVALUATOR INFORMATION:

Name of Evaluator: _____________________________ Title: _______________________________

Position held or Function in relation to Project

Company/Agency Name:

Address:

Telephone Number:

FAX _____________________________________

Email Address:

FAX/EMAIL completed surveys to Lilian Librodo at 510-535-7233 (Lilian.L.Librodo @uscg.mil). Mail to CEU Oakland, Attn: L. Librodo, 2000 Embarcadero, Suite 200, Oakland, CA 94606-5337.

D.

PERFORMANCE INFORMATION: Choose the letter(s) that most accurately describes the contractor’s performance or situation. Please provide a narrative explanation for any ratings of U, M, or E.

U

M

N

S

VG

E

Unsatisfactory

Marginal

None

Satisfactory

Very Good

Exceptional

Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective.

Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.

No record of past performance or the record is inconclusive.

Performance met contract requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.

Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems which the contractor resolved in a timely, effective manner.

Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner

Please circle the appropriate rating and provide any supporting information/comments for the following:

YES NO

YES NO

21.

CUSTOMER SATISFACTION: Was the customer satisfied with the end product? If no, please explain.

YES NO

U M S N VG E

Print Name ____________________________________

Signature of Evaluator DATE

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