Past Performance Questionnaire Attachment 2.pdf

Past Performance Questionnaire Attachment 2

“Source Selection Information” in accordance with FAR 3.104.

DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

DIRECTOR OF OPERATIONAL LOGISTICS DOL-9 / DOL-95

300 EAST MAIN STREET, SUITE 965

NORFOLK, VA 23510-9112

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

REQUEST FOR QUOTES NUMBER: 70Z08421QBB109300

In order to assess potential vendors, the U.S. Coast Guard, Director of Operational Logistics (DOL-9) contracting office is obtaining past performance information with respect to each offeror. The offeror has identified you as a reference to validate the offeror’s past performance. This PPQ must be completed by the Past Performance Reference (i.e. you), NOT the Offeror, and submitted directly to USCG, DOL-9- DOL-95 by the Past Performance Reference. The completed PPQ shall not be released to the offeror. 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 by E-mail: Vicente.M.Macho@uscg.mil.

Please contact the Contract Specialist, Vicente Macho, at (757) 628-4490 to confirm receipt, and if you have any questions. The completed PPQ is due on or before May 14, 2021, 12:00 PM Eastern Standard Time.

I. GENERAL GUIDANCE

Please use the following rating in scoring the performance elements below (assessments should reflect only contractor-liable performance):

RATING DESCRIPTION

Exceeds The Contractor's past performance far exceeds the customer's expectations and provided significant, unusual worthwhile features or benefits.

Satisfactory The Contractor's past performance met the customer's expectations and contract requirements.

Marginal The Contractor's past performance could have been improved. The Contractor required major agency resources to ensure achievement of contract requirements.

Unsatisfactory The Contractor's past performance did not meet customer expectations and/or contract requirements.

II. GENERAL INFORMATION

A. PAST PERFORMANCE REFERENCE & AGENCY IDENTIFICATION:

1 Name:

2 Title:

3 Organization/Agency:

4 Address:

mailto:Vicente.M.Macho@uscg.mil

“Source Selection Information” in accordance with FAR 3.104.

5 Phone Number:

6 Fax Number:

7 E-mail Address:

8 Date:

9 Signature:

B. CONTRACTOR & CONTRACT IDENTIFICATION:

1 Name of Contractor:

1 Type of Instrument (e.g. Contract/BPA/Order/Other):

2 Contract Number:

3 Order Number (if applicable):

4 Project Title and Service/Supply Description (add rows if needed):

5 Type of Contract (e.g. Negotiated, Sealed Bid):

6 Pricing Type (e.g. Fixed Price, T&M, Cost Reimbursement, other):

7 Competitive (Y/N):

8 Follow-On (Y/N):

9 Date of Award:

10 Initial Contract Dollar Value (w/Options):

11 Final Contract Dollar Value (w/Options):

12 Period of Performance:

13 Place(s) of Performance:

14 Complexity of Work (e.g. difficult, routine):

15 If applicable , type and extent of subcontracting:

“Source Selection Information” in accordance with FAR 3.104.

C. GENERAL INFORMATION

1 Has the Contractor ever been given a cure notice, show cause notice, suspension of progress payments, etc.? If yes, explain. No / Yes

2 Has this contract been partially or completely terminated? If yes, explain and identify type of termination (e.g. default, convenience, cause). No / Yes

3 If this was an award or incentive fee contract, what percentage of the available fee did the Contractor usually receive?

Changes in contract dollar amounts throughout the life of the contract are/were generally attributable to customer-issued Change Orders, Contractor-submitted claims, other Customer actions (please explain):

III. EVALUATION: How Would You Rate This Contractor With Respect To:

A. Compliance with the Specifications; conformance to standards of good workmanship, and responsiveness to technical direction:

Rating Exceeds Satisfactory Marginal Unsatisfactory Check √

Summary:

B. Adherence to the contract delivery schedule:

“Source Selection Information” in accordance with FAR 3.104.

C. Adherence to contract/task order estimates; reasonableness of change order proposals; and completeness of billing:

D. Working relationship with Contracting Officer, Contract Specialist, COTR, and other points of contact:

E. Relationship with and satisfaction level of agency end-user of product or service required:

IV. SUMMARY

Would your agency/organization award another contract to this Contractor? Yes / No

In summary, if you care to, please give your overall assessment of this contractor.

Do you have any additional comments to add?