Sect_L_Appendix_4_-_Past_Performance_Questionnaire.pdf

NASA/KSC SOLICITATION 80KSC0-18-R-0002

SECTION L - APPENDIX 4

PAST PERFORMANCE QUESTIONNAIRE

Restore KSC Coastal Shoreline

NASA Kennedy Space Center’s solicitation requires offerors to provide this Past Performance Questionnaire to customers to complete and return to NASA. Past performance raters are requested to submit the completed questionnaires to the contracting officer identified below via e-mail, to arrive not later than the proposal submission date.

Completed questionnaires should be sent to:

Name: C. M. Julius Williams Email: Christopher.M.Williams@nasa.gov Address: NASA John F. Kennedy Space Center, Mail Stop: OP-CS Kennedy Space Center, Florida 32899

Raters are requested to complete the questionnaire forms as written since altered or substituted questionnaires may not adequately address the information NASA will be evaluating.

SECTION I. THIS SECTION TO BE COMPLETED BY THE OFFEROR

Name of Contractor Being Evaluated:______________________________________________

Name of Project and Contract/Order Number:________________________________________

Period of Contract Performance (dates):_____________________________________________

Place of Contract Performance:____________________________________________________

Contract Value at Award:_________________________________________________________

Contract Value at Completion or Current Contract Amount:______________________________

Contract Status (Prime or Subcontract?):_____________________________________________

Point of Contact: (Rater) Name/Address/Office Phone Number/E-Mail Address:

PAST PERFORMANCE QUESTIONNAIRE

THIS SECTION TO BE COMPLETED BY THE RATER

(THIS QUESTIONNAIRE, WHEN COMPLETED, SHALL NOT BE DISCLOSED TO

ANYONE OUTSIDE THE GOVERNMENT)

Name of Contractor Being Evaluated:______________________________________________

Name of Project and Contract/Order Number:________________________________________

Period of Contract Performance (dates):____________________________________________

Place of Contract Performance:___________________________________________________

Contract Value at Award:________________________________________________________

Contract Value at Completion or Current Contract Amount:_____________________________

Contractor’s Status (Prime or Subcontractor?):_______________________________________

Percentage and Dollar Value of Work Performed by the Contractor:

Dates of Rater’s Involvement in Program/Contract:___________________________________

Brief Description of Work Performed:

Point of Contact: (Rater) Name/Address/Office Phone Number/E-Mail Address:

PAST PERFORMANCE QUESTIONNAIRE

RATING DEFINITIONS:

On a scale of 1 to 5, with 1 being unsatisfactory and 5 being exceptional, please rate the contractor on the past performance areas included in this questionnaire. A rating of N/A should be used if the question is not applicable or the answer is unknown. Space is provided for any additional comments raters may want to provide. The definitions associated with the 1 to 5 ratings are provided below:

1. UNSATISFACTORY: Performance does (did) not meet most contractual requirements and recovery is not likely (did not occur). The contractual performance contains (contained) serious problem(s) for which the contractor’s corrective actions appear ineffective (were ineffective).

2. MARGINAL: Performance does (did) not meet some contractual requirements. The contractual performance reflects (reflected) serious problem(s) for which the contractor has not yet identified acceptable corrective actions (did not provide acceptable corrective actions).

3. SATISFACTORY: Performance meets (met) contractual requirements. The contractual performance reflects (reflected) some minor problems. Corrective actions being taken by the contractor appear to be effective (Corrective actions taken were effective).

4. VERY GOOD: Performance meets (met) contractual requirements and exceeds (exceeded) some of the Government’s expectations. The contractual performance reflects (reflected) some minor problems and corrective actions being taken by the contractor appear to be effective (Corrective actions taken were effective).

5. EXCEPTIONAL: Performance meets (met) contractual requirements and exceeds (exceeded) many of the Government’s expectations. The contractual performance reflects (reflected) few minor problems and corrective actions taken by the contractor appear to be highly effective (corrective actions taken were effective).

N/A: Not applicable or rater has not observed performance in this area.

PAST PERFORMANCE QUESTIONNAIRE

CONTRACTOR’S TECHNICAL PERFORMANCE QUESTIONS

1. The effectiveness of the Contractor’s overall project management ability (including but not limited to project managers, quality control managers, trade integrators, safety managers, and superintendents); labor (skilled and unskilled workers); equipment; supplies; tools; and financial resources to successfully perform, provide contract deliverables and complete work in a safe and timely manner.

1 2 3 4 5 NA

Comments:

2. The Contractor’s ability to provide timely and effective contractor management attention at the job site and partner with the owner to resolve technical and schedule issues.

1 2 3 4 5 NA

Comments:

3. The Contractor’s ability to provide quality engineering shop drawings and accurate and complete as-built documentation.

1 2 3 4 5 NA

Comments:

4. The Contractor’s ability to manage or perform embankment activities. Embankment activities in compliance with environmental regulations.

1 2 3 4 5 NA

Comments:

PAST PERFORMANCE QUESTIONNAIRE

5. The Contractor’s ability to transport large quantities (more than 10,000 cubic yards) of fill material in compliance with the contract/project’s specifications.

1 2 3 4 5 NA

Comments:

6. The Contractor’s ability to provide technical information of fill material from a source/supplier that meets a stringent or pre-determined specification, and adherence to the specifications.

1 2 3 4 5 NA

Comments:

7. The Contractor’s ability to create, maintain, and comply with a safety and health program with visible management control and involvement during the duration of the contract.

1 2 3 4 5 NA

Comments:

8. The Contractor’s ability to provide project completion within ten percent (10%) of original contract cost and schedule. Please provide comments on any changes greater than 10% that were not customer driven.

PAST PERFORMANCE QUESTIONNAIRE

9. The Contractor’s ability to maintain acceptable Days Away Restricted or Transferred (DART) Rates, Total Case Rates (TCR), Days Away From Work Injury Illness (DAFWII), and Experience Modification Ratings (EMR) for the previous three years.

1 2 3 4 5 NA

Comments:

CONTRACTOR’S SAFETY PERFORMANCE QUESTIONS

10. The Contractor’s ability to maintain a safety and health program with visible management control and involvement.

1 2 3 4 5 NA

Comments:

11. The Contractor’s ability to maintain a safety program ensuring subcontractors’ safety performance was consistent with the prime contractor’s safety program.

1 2 3 4 5 NA

Comments:

12. The Contractor’s ability to analyze worksite hazards prior to the start of work to ensure that all hazards were abated.

PAST PERFORMANCE QUESTIONNAIRE

13. The Contractor’s ability to understand and comply with safety requirements.

1 2 3 4 5 NA

Comments:

14. The Contractor’s ability to maintain a safety program that ensured the customer’s critical resources were adequately protected with emergency procedures for securing dangerous conditions and protecting personnel during contract performance.

1 2 3 4 5 NA

Comments:

15. The Contractor’s ability to resolve safety discrepancies in a timely and effective manner and the ability to report, investigate, and take corrective actions on safety accidents/incidents in a timely and effective manner.

1 2 3 4 5 NA

Comments:

CONTRACTOR’S CONTRACT ADMINISTRATION PERFORMANCE QUESTIONS

16. The contractor’s ability to provide prompt payment of employees, subcontractors, and suppliers for services and supplies performed/delivered under the contract.

PAST PERFORMANCE QUESTIONNAIRE

17. The contractor’s compliance with Department of Labor requirements and resolution of reported violations/discrepancies.

1 2 3 4 5 NA

Comments:

18. The contractor’s compliance with contract subcontracting plan goals for small disadvantaged business (SDB) concerns. (Applicable only to Large Business Offerors)

1 2 3 4 5 NA

Comments:

19. Has the contractor’s performance required the issuance of any cure notices, show cause letters, or terminations for cause/default? (Please circle Yes or No)

Yes No

Comments:

CONTRACTOR’S OVERALL CONTRACT PERFORMANCE

20. Would you select this contractor again? (Please circle Yes or No)

Yes No

Comments:

THIS COMPLETED QUESTIONNAIRE WILL NOT BE DISCLOSED TO ANYONE

OUTSIDE THE GOVERNMENT. THANK YOU FOR TAKING THE TIME TO

COMPLETE THIS QUESTIONNAIRE.