Past Performance Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

TO REFERENCE: (Enter name of reference entity the questionnaire is being sent to)

REFERENCE’S PHONE NUMBER:

REFERENCE’S EMAIL:

FROM REQUESTING FIRM:

(Name of Firm and contact information of the person requesting the accomplishment of the questionnaire.)

Your assistance is requested in support of a source selection. The USMC Blount Island Command is in the process of soliciting offers from companies capable of providing Stevedoring and Routine Terminal Services. [Our firm] has provided your name and organization as a reference regarding our record of past performance under Contract No. [CONTRACT NO.].

Please complete this Questionnaire and forward a PDF copy to Michal Anderson, Contracting Officer, at michael.s.anderson@usmc.mil.

[Our firm] is competing for Solicitation #M67004-20-R-0003 as a:

Prime Contractor

When complete, the information on this form is SOURCE SELECTION SENSITIVE INFORMATION (41 U.S.C. 423) and shall be protected accordingly.

SECTION I - TO BE COMPLETED BY OFFEROR

1. CONTRACTOR NAME & ADDRESS:

2. CONTRACT NO.:

3. CAGE CODE:

4. PERIOD OF PERFORMANCE:

5. COMPETITIVELY AWARDED (circle one) YES or NO

6. INITIAL CONTRACT VALUE (with options): $

7. CURRENT CONTRACT VALUE (with options): $

8. TYPE OF CONTRACT:

9. REASONS FOR DIFFERENCE (IF ANY) BETWEEN INITIAL CONTRACT VALUE AND CURRENT CONTRACT VALUE:

10. DESCRIPTION OF CONTRACT REQUIREMENTS:

Please add a continuation page if additional space necessary.

SECTION II - EVALUATION - TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

13. EVALUATOR’S TITLE:

14. EVALUATOR’S PHONE NUMBER:

15. EVALUATOR’S EMAIL ADDRESS:

16. NUMBER OF YEARS OR MONTHS EVALUATOR HAS MONITORED CONTRACTOR’S PERFORMANCE:

17A. INDIVIDUAL RATINGS EVALUATION:

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

E EXCEPTIONAL - Quality of performance exceeded all contractual requirements and expectations. The contract performance specification was accomplished with only minor problems for which corrective actions taken by the contractor were highly effective. The contractor was pro-active in identification of problems, providing alternatives and recommendations.

VG VERY GOOD - Quality of performance met contractual requirements and exceeded many expectations. The contract scope of work was accomplished with some minor problems for which corrective actions taken by the contractor were highly effective.

S SATISFACTORY – Quality of performance met contractual requirements. The contract scope of work was accomplished with some problems for which corrective actions taken by the contractor were satisfactory.

M MARGINAL – Quality of performance did not meet some contractual requirements. The contract scope of work had some serious problems which the contractor did not resolve to the customer’s satisfaction. The contractor’s proposed corrective actions appeared to be only marginally effective or were not fully implemented by the contractor.

U UNSATISFACTORY – Quality of performance did not meet most contractual requirements and recovery is not likely in a timely manner. The contract scope of work performance had major problems for which the contractor’s corrective actions were ineffective.

NA NOT APPLICABLE - Unable to provide a score as the question does not apply.

T1. Quality of Product or Service. Ability of Contractor to: provide accurate deliverables/reports; meet service specifications of the contract; provide timely proposals; respond to short notice requirements; provide and adhere to quality control/management plan (when required)

T2. Schedule. Ability of Contractor to provide deliverables/reports required by the contract on time

T3. Cost/Price Control. Ability of Contractor to: provide accurate contract costs/estimates; track and control costs; meet and perform within negotiated costs; provide current, accurate and complete invoices/billing; submit cost reporting information in a timely manner

T4. Outside the Continental United States (OCONUS) Support. Ability of Contractor to: obtain and retain required clearances and documentation for OCONUS performance; adhere to applicable guidance, instructions, directives for OCONUS performance.

T5. Business Relations. Ability of Contractor to: maintain effective relationship between key Contractor personnel and key Government personnel; manage, resolve problems and respond to and/or integrate changes in mission-related requirements

T6.

T7.

T8

T9.

T10.

T11.

T12

T13

T14

M1. Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

M2. Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

M3. Timeliness/effectiveness of contract problem resolution without extensive customer guidance

M4. Understand/complied with customer objectives and technical requirements

M5. Successfully responded to emergency and/or surge situations

M6. Quality/effectiveness of sub-contracted efforts

M7. Effectiveness of material management (including Government Furnished Property, Information, or Material)

M8. Effectiveness of acquisition management

M9. Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

M10. Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

M11. Successfully managed an integrated team inclusive of subcontractors/teammates.

M12. The Contractor’s management plans met the customer’s requirements and resulted in efficient, effective and adaptable program planning and execution

M13. Obtained and updated the human knowledge capital required for successful contract execution

M14. Retained Key Personnel, staff and subcontractors with sufficient qualifications, experience and had successful methods for accommodating changes in staffing levels in a dynamic environment which yielded efficient, effective and adaptable planning and execution of the program

M15. Successfully recruited and retained employees qualified for the effort

T1. Phase-In

T2. Phase-Out

S1. Ability to meet or exceed small business and small disadvantaged business goals set forth in the approved subcontracting plan, as applicable.

S2. Ability to effectively manage small business participation to meet technical performance, as applicable.

S3. The extent to which small business firms were actively considered for participation in the performance of the contract.

C1 Accuracy in forecasting contract costs

C2 Demonstrated ability to meet forecasted costs and perform within contract costs

C3 Demonstrated ability to alert Government of unforeseen costs before they occur

C4 Sufficiency and timeliness of cost reporting

17B. Please discuss each response for which you indicated E (Exceptional), M (Marginal) or U (Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

18. OVERALL EVALUATION RATING (circle one):

Overall Assessment: (a) EXCEPTIONAL (b) VERY GOOD (c) SATISFACTORY (d) MARGINAL (e) UNSATISFACTORY (f) NOT OBSERVED

19. Any unsatisfactory performance identified above has been shared with the contractor. ( ) Yes: written or oral ? ( ) No

20. Government Contracts ONLY: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes___ Default___ Convenience___ Pending Terminations___ No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

21. Would you have any reservations about soliciting this Contractor in the future or having them perform one of your critical and demanding programs?

Yes___ No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

22. COMPLETED BY: __________________________________________________ (Name, Title, Date)

__________________________________________________________________________ (Signature)

__________________________________________________________________________ (Address)

__________________________________________________________________________ (Point of Contact Information)