Past Performance Questionaire.pdf

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PAST PERFORMANCE QUESTIONAIRE

CONTRACT INFORMATION (Quoter to complete Blocks 1-4)

1. Offeror Information:

Firm name: _____________________________________ CAGE Code: ________________________

Address: _______________________________________ UEI Number: ________________________

Phone Number: _________________________________

Email Address: __________________________________

Point of Contact: _________________________________

Contact Phone Number: ___________________________

2. Work Performed as: Prime Contractor Subcontractor Joint Venture

Other (Explain): __________________________________________________________________

Percent of Project work performed: _____________%

If subcontractor, who was the prime (Name): ____________________

Phone #: _____________________________

3. Contract Information

Contract Number: _____________________________________________

Delivery/Task Order Number (if applicable): _________________________

Contract type: Firm Fixed Price Cost Reimbursement Other (please specify):

Contract Title: _____________________________________________________________________

Award Date (mm/dd/yy): _____________________________________________________________

Contract Completion Date (mm/dd/yy): __________________________________________________

Actual Completion Date (mm/dd/yy): ____________________________________________________

Explain Differences: _________________________________________________________________

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PAST PERFORMANCE QUESTIONAIRE

Original Contract Price (Award Amount): _________________________________________________

Final contract Price (to include all modifications, if applicable): ________________________________

Explain Differences: _________________________________________________________________

4. Project Description:

Complexity of Work High Med Routine

How is this project relevant to this solicitation’s requirements? (Please provide details, i.e., similar equipment, requirements, conditions, staffing etc.):

REFERENCE INFORMATION (Client to complete Blocks 5-8)

5. Client Information:

Name: _________________________________

Title: __________________________________

Phone Number: _________________________

Email Address: __________________________

6. Describe the client’s role in the project: _____________________________________________

PAST PERFORMANCE QUESTIONAIRE

See Ratings and Definitions on next page

Overall Contractor Quality: __________________________________________________________

Overall Contractor Timeliness/On Schedule: ___________________________________________

Overall Contractor Management/Staffing: ______________________________________________

Overall Rating for Work Performed: ___________________________________________________

Any additional comments regarding the contractor’s performance: _____________________________

7. Date Questionnaire was completed (mm/dd/yy): ________________________

8. Client’s Signature: ________________________________________________

NOTE: USCG REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNARIE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE QUOTER SHALL SUBMIT THE COMPLETED QUESTIONNARIE WITH THEIR QUOTE. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS

FORM.

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S OVERALL PERFORMANCE

RATING DEFINITION NOTE

(E) Exceptional Performance meets contractual requirements and exceeds many to the Government/Owner’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.

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

(VG) Very Good Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been no significant weaknesses identified.

(S) Satisfactory Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract. There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

(M) Marginal Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit. The contractual performance of the element or sub-element being assessed 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.

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

(U) Unsatisfactory Performance does not meet most contractual requirements, and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating.

(N) Not Applicable

Equivalent to Neutral Adjectival Rating

No information or did not apply to your contract Rating will be neither positive nor negative.