18_ATTCH_4New Past Performance Questionaire

HSCG89-09-R-65M206

District 14

PAST

PERFORMANCE

SURVEY

NAME OF OFFEROR:_______________________________________________________________________

PROJECT REFERENCED:

1. Title:_____________________________________________________________________________________

2. Contract or Identifying Number:_______________________________________________________________

3. Period of Performance:___________________________ Dollar Value: ________________________________

4. Description of services performed:______________________________________________________________ Relevant Experience and Complexity:

Preventive and Emergency Maintenance Services?________________________________________________________ VHF-FM radio, Nationwide Automated Information Systems, Microwave Communications Systems and associated Components Maintained?_______________________________________________________________________________________________________________________________________________________________________________________________ Generators Maintenance and Fueling Services?____________________________________________________________ Property Management?__________________________________________________________________________________ 24/7 casualty response?___________________________________________________________________________________ Questionnaire Completed by: ________________________________________Date:______________________

Company: ____________________________________ Title:_________________________________________

Phone Number: ________________________________ Fax Number:___________________________________

Rate the contractor in the listed performance areas utilizing the following guide. Circle appropriate response for yes/no questions. Please provide comments.

Ratings:

E = Excellent S= Satisfactory U = Unsatisfactory

N = Not Observed

A. CUSTOMER SERVICE QUALITY:

1. Did Contractor meet quality requirements of the product or service?

E S U N

Comments:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. . Was there a commitment on the contractor’s part to provide effective customer service? If not, please explain.

Yes No Comments:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Would you recommend or conduct business with this contractor again? If not, please explain.

Yes No

Comments:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Overall rating:____________

B. CONTRACT ADMINISTRATION HISTORY (Contracting Office fills out))

1. Has the contractor been issued Contract Discrepancy Reports (CDR’s) and if so, was the problem corrected satisfactorily?

No

2. Was there an excessive amount of CDR’s issued?

3. Have either a Cure Notice or Show Cause Letter ever been issued to the contractor?

4. When applicable, does the contractor properly handle and dispose of hazardous waste?

5. Does the contractor comply with all applicable labor standards?

6. Has an election ever been made to not exercise an option due to contractor’s poor performance? If yes, please explain.

7. Was communication with the contractor cooperative, responsive and productive? (Response to modifications, letters, etc.)

Yes No

C. CONTRACT PERFORMANCE

1. Was the contractor timely in delivery of preventive maintenance services to the contracted schedule?

3. Was the contractor timely in responding to emergency site outages, if any?

4. Has the contractor been assessed any liquidated damages or deductions for late or non-performance of services?

5. Was the contractor timely in providing reports for services provided, if any?

6. Did the contractor fail any property or inventory audits?

E S U N

Overall Rating: _______________

COMMENTS:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D. COST CONTROL

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

Yes

No (If yes, please explain.)

Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Does the contractor have any outstanding claims or debts in excess of $2,500? Yes No (If yes, please explain)_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Overall Rating: _______________

E. SUMMARY

1. What would be your overall and final rating for this contractor?

E S U N Past performance Questionnaire, (to be filled out by Customer, and Mail directly to Coast Guard, kathryn .m.rato@uscg.mil)

ATTCH4