S1.12a ATTACHMENT 5 - Performance Questionnaire.docx

DOCX document 21 KB Posted

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USCG SFLC 87' WPB MTU Component Overhauls & Parts Purchase
Solicitation number
70Z08021R13002B00
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Solicitation # 70Z08021R13002B00

PAST PERFORMANCE QUESTIONNAIRE

Contract #: ___________________________________________________________________________

Individual Completing Questionnaire: ______________________________________________________

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Total Contract Value:

IDENTIFICATION OF OFFEROR’S REFERENCE REPRESENTATIVE

Name:

Title:

Date:

Telephone Number:

Address E-mail Address:

The same ratings used in the Contractor Performance Assessment Review System shall be used to evaluate Past Performance in this questionnaire.

A common five level assessment rating system is used to evaluate a contractor’s performance. Ratings range from Unsatisfactory to Exceptional.

0 = Unsatisfactory
Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.
1 = Marginal
Performance does not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.
2 = Satisfactory
Performance meets contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
3 = Very Good
Performance meets contractual requirements and exceeds some to the Governments benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
4 = Exceptional
Performance meets contractual requirements and exceeds many to the Governments benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

*Rationale required for each answer.

Unsatisfactory
Marginal
Satisfactory
Very Good
Exceptional
0
1
2
3
4
N/A
1.
Compliant with specifications, reports and maintained required documents

*Rationale:

0
1
2
3
4
N/A
2.
Effectiveness of project management (to include use and control of subcontractors) (check box)

*Rationale:

0
1
2
3
4
N/A
3.
Timeliness of performance and product deliverables (check box)

*Rationale:

0
1
2
3
4
N/A
4
Quality of workmanship (check box)

*Rationale:

Unsatisfactory
Marginal
Satisfactory
Very Good
Exceptional
0
1
2
3
4
N/A
5
Commitment to customer satisfaction and business-like concern for its customers’ interests (check box)

*Rationale:

6
Any additional information you would like to add:

SOURCE SELECTION INFORMATION – SEE FAR 2.101 and 3.104 Page 1 of 3

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