NSF Past Performance Survey 20240223.docx

49100423R0010 Attachment 5

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: ☐Prime Contractor ☐Subcontractor ☐ Joint Venture ☐ Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #/Email):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: ☐ Firm Fixed Price ☐ Cost Reimbursement ☐ Other (Please specify): Contract Title:

Contract Performance Location(s):

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy) (if applicable):

Actual Completion Date (mm/dd/yy) (if applicable):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE OFFEROR’S PERFORMANCE

The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

performing beyond the requirements of the contract.

proposed actions appear only marginally effective or were not fully implemented.

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

magnitude that it alone constitutes an unsatisfactory rating.

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PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

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

E

VG

S

M

U

N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

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)

E

VG

S

M

U

N

3. CUSTOMER SATISFACTION:

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)

E

VG

S

M

U

N

4. MANAGEMENT/ PERSONNEL/LABOR

5. COST/FINANCIAL MANAGEMENT

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)

VG

S

M

U

N

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

Yes

No

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.

Yes

No

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

Yes

No

6. SAFETY/SECURITY

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.)

E

VG

S

M

U

N

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

7. GENERAL

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).

VG

S

M

U

N

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

Yes

No

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):