032 4Req SF330s AttC.docx

Attachment JL.19, Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

Must be completed and returned, by the Client Reference, to Carley.Flaxman@noaa.gov and Dorothy.Curling@noaa.gov by the Request for SF330 closing date.

Contractor to complete Contractor Information and Contract Information.

CONTRACTOR INFORMATION

To be completed by Contractor.

Contractor Name

Contractor Address

Unique Entity Identifier (UEI) Number

Contractor Point of Contact Name, Phone Number, and Email Address

CONTRACT INFORMATION

To be completed by Contractor.

Contract Number and Delivery/Task Order Number (if applicable)

Contract Type:

Complexity of Work (High, Med, Routine):

Work Performed As (Prime, Subcontractor, Joint Venture, etc.). If subcontractor, who was the prime (Name/Phone #).

Percent of project work performed

Date of Contract Award

Contract Completion Date and Actual Completion Date (if different, explain)

Dollar Value (Annual and Total)

Original Contract Price and Final Contract Price (if different, explain)

Percent Invoiced

Contract Title

Contract Location

Contract Agency or Commercial Entity

Contract Agency or Commercial Entity Reference Name, Phone Number, and Email Address

CLIENT INFORMATION

Client reference to complete this table and the remainder of this form. Client reference shall complete and submit to Carley.Flaxman@noaa.gov and Dorothy.Curling@noaa.gov by the Request for SF330 closing date.

Client Reference Name, Title, Phone Number, and Email

Describe role as the Client in the project

Date Questionnaire was completed (mm/dd/yy)

Client Reference’s signature

NOTE: 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 PERFORMANCE

TO BE COMPLETEDAND SUBMITTED BY CLIENT REFERENCE

PLACE AN ‘X’ IN THE BOX OF THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

a) Quality of technical data/report preparation efforts

b) Ability to meet quality standards specified for technical performance

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance)

QUALITY OVERALL RATING

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below)

b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract

SCHEDULE/TIMELINESS OVERALL RATING

a) To what extent were the end users satisfied with the project?

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication)

c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

d) Overall customer satisfaction

CUSTOMER SATISFACTION OVERALL RATING

a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force?

b) Ability to hire, apply, and retain a qualified workforce to this effort

c) Government Property Control

d) Knowledge/expertise demonstrated by contractor personnel

e) Utilization of Small Business concerns

f) Ability to simultaneously manage multiple projects with multiple disciplines

g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes

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

MANAGEMENT/PERSONNEL/LABOR OVERALL RATING

a) Ability to meet the terms and conditions within the contractually agreed price(s)?

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns)

d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section.

e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

COST/FINANCIAL MANAGEMENT OVERALL RATING

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

b) Contractor complied with all security requirements for the project and personnel security requirements.

SAFETY/SECURITY OVERALL RATING

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

b) Compliance with contractual terms/provisions (explain if specific issues)

c) Would you hire or work with this firm again? (If no, please explain below)

d) In summary, provide an overall rating for the work performed by this contractor.

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):