Past_Performance_Questionnaire.pdf

DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD BASE NEW ORLEANS

1790 SATURN BLVD NEW ORLEANS, LA 70129

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

REQUEST FOR QUOTES NUMBER: 70Z02921Q3JM482

In order to assess potential vendors, the U.S. Coast Guard Base New Orleans 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 Base New

Orleans 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 Contracting Officer by email: Sterling.T.Davis@uscg.mil

The completed PPQ is due on or before June 15, 2021, 3:30 PM Central 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:

mailto:Sterling.T.Davis@uscg.mil

4 Address:

5 Phone Number:

6 Fax Number:

7 E-mail Address:

8 Date:

9 Signature:

B. CONTRACTOR & CONTRACT IDENTIFICATION:

1 Name of Contractor:

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):

Type of Contract

(e.g. Negotiated, Sealed Bid):

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:

Complexity of Work

(e.g. difficult, routine):

15 If applicable , type and extent of subcontracting:

C. GENERAL INFORMATION

Has the Contractor ever been given a cure notice, show cause notice, suspension of progress payments, etc.? If yes, explain.

No / Yes

Has this contract been partially or completely terminated? If yes, explain and identify type of termination (e.g. default, convenience, cause).

No / Yes

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:

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?