80KSC019R0019 Attachment L-01 NEMCON Past Perf Questionnaire.docx

ATTACHMENT L-01

RELEVANT EXPERIENCE AND PAST PERFORMANCE QUESTIONNAIRE

FOR

NASA ENVIRONMENTAL AND

MEDICAL CONTRACT (NEMCON)

PAST PERFORMANCE QUESTIONNAIRE

NASA ENVIRONMENTAL AND MEDICAL CONTRACT (NEMCON)

This questionnaire is to be submitted for the evaluation of a company that has intentions to compete for the NEMCON contract as a prime or subcontractor. The following terms, “customer reference” and “evaluator” are used to refer to the person (customer) performing the evaluation.

NASA requires the Offeror (company) to provide this questionnaire to customer references for which it has had recent contracts that are similar in size, content, and complexity to the requirements of the NEMCON solicitation that are currently in progress or have been completed within the last five (5) years. Recent is defined as performance within the last five (5) years, as of proposal due date, for ongoing or completed contracts.

Instructions for completing the Past Performance questionnaire and a sample cover letter to send to your customer reference for performance assessment are included in the following pages. Please request that the customer reference complete the attached questionnaire and email a PDF file to Brandi Roberts, Contracting Officer, at ksc-NEMCON-Info@mail.nasa.gov.

The completed questionnaire will become a part of the official source selection records.

NEMCON

80KSC019R0019

Complete one letter and form for each Past Performance reference. Additional space or blank sheets may be added to answer any question.

Transmittal Letter to Accompany Present/Past Performance Questionnaire

TO: (Insert customer name here)

FROM: (Fill in your firm’s name here)

SUBJECT: Present/Past Performance Questionnaire for Contract(s):

We are currently responding to NASA Kennedy Space Center’s (KSC’s) Request for Proposal (RFP) 80KSC019R0019 to provide environmental, medical, and occupational health support services at KSC, NASA Headquarters, and the United States Air Force 45th Space Wing. This RFP requires Offerors to identify customers and solicit their response regarding our performance. We are providing present and past performance data to NASA KSC relating to our performance on contract [Insert Contract Name/Number].

The RFP instructs that we provide our customers with the attached questionnaire and requests that you complete the attached questionnaire and email a PDF file to, Brandi Roberts, Contracting Officer, at ksc-NEMCON-info@mail.nasa.gov by [Insert Date].

Our firm is competing for Solicitation # 80KSC019R0019 as a:

________Prime Contractor

________Subcontractor

The information contained in the completed Past Performance Questionnaire is considered sensitive and cannot be released to us, the Offeror. If you have any questions about the acquisition or the attached questionnaire, your questions must be directed back to the KSC point of contact identified above. Thank you for your timely assistance.

We have identified the following individual from your organization as the point of contact to complete the questionnaire:

POC/TITLE:

Phone Number: Email Address:

Sincerely, SECTION 1: GENERAL INFORMATION

OFFEROR IDENTIFICATION

Company Name:

Company Address:

Cage Code or DUNS number:

Contract Number:

Contract Type:

Description of Work Performed:

Contract Award Date:

Period of Performance (basic and any options):

During contract performance, Offeror was the (list all that apply):

· Prime

· Subcontractor

· Joint Venture Member

· Team Member

Total Contract Value

Percentage of the total contract value performed by Offeror

EVALUATOR INFORMATION

Name of evaluator:

Telephone number and email address of evaluator:

Position title:

Agency/Company (Name, Division, Address):

Your role in the program/contract

Length of involvement in this program/contract:

Does a corporate or ownership relationship exist between the Offeror being evaluated and your firm? If yes, please describe:

Date questionnaire completed:

SECTION 2: PAST PERFORMANCE EVALUATION RATINGS

Please provide your assessment of the amount of work performed under the contract for which you are a reference. The following definitions are offered for your use:

(a) Significant (SIG) means that a full range of services was routinely performed by the contractor under the associated description.

(b) Moderate (MOD) describes a contractor who has experience in several aspects of an associated description even though the experience may not have been on a continuous basis or directly related to services performed under the contract.

(c) Minimal (MIN) means that, although at least some aspects of the work may have been performed, such performance was limited in scope or frequency.

(d) N/A performance is not available or not applicable to the stated description.

Performance Ratings: Based on your knowledge of the contract identified above, please provide your assessment of how well the Contractor performed on the questions listed in the table below. It is very important to keep in mind that only performance in the past 5 years is relevant. You are strongly encouraged to give a short narrative indicating why you chose the adjective you did, especially for those answers that are “Exceptional,” “or “Marginal,” or “Unsatisfactory”. The following definitions are offered for your use in assigning a performance rating:

(a) Exceptional (E) Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

(b) Very Good (VG) Performance meets and exceeds some of the contractual requirements to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

(c) Satisfactory (S) Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

(d) Marginal (M) Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

(e) Unsatisfactory (U) Performance does not meet most of the contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

(f) Not Applicable (N/A) Performance is not available or not applicable to the stated description.

SECTION 3: PERFORMANCE EVALUATION

Description

TECHNICAL PERFORMANCE AREAS

Occupational Medicine Clinic Operation Comments:

Preventive Medicine, Health Education, and Wellness Programs

Employee Assistance Program

Aerospace Medicine

Fitness Center Operation

Rehabilitation Services

Clinical Laboratory Services

Industrial Hygiene Services

Health Physics (Radiation Safety)

Sanitation and Public Health

Environmental Laboratory Services

Environmental Compliance Program Management (air, wastewater, spill plans, storage tanks, etc.)

Environmental Permit Application Preparation

Hazardous and Controlled Waste Management and Disposal

Environmental Sampling/Analysis (air/soil/water)

Environmental Spill Response/Mitigation

Threatened and Endangered Species Management

Ecological Land Management

Ecological and Cultural Resources Geographic Information System Support and Data Management

Energy/Water Program Management, Project Implementation and Performance Management, and Reporting

National Environmental Policy Act Assessments

Greenhouse Gas Emissions Calculations and Reporting

Cultural and Natural Resource Management Plan Development

Compliance with technical requirements and performance standards

Overall technical performance

MANAGEMENT PERFORMANCE

Builds effective working relationships with associate contractors, subcontractors and the Government in a team environment

Composition of project management team (adequate number of managers)

Develops and implements management functions to ensure all contracted activities were accomplished in accordance with contract terms and conditions

Identifies problems and proposes acceptable solutions in a timely manner

Works effectively with the customer

80KSC019R0019-DRAFT

NEMCON

Effectively coordinates, integrates, and manages subcontractors

Provides and maintains management systems for the planning, organization, control, and reporting of all activities required by the contract

Uses metrics, risk management, and other tools to accurately measure and track performance

Responsiveness to changes in technical direction

Manages and executes OSHA compliance and contract-specific health and safety requirements

Recruits and retains highly skilled personnel, including ability to fill key vacancies in a timely manner

Did the Contractor effectively staff key positions and retain key personnel?

Resolves problems without customer direction/intervention

Handles fluctuating workloads

Effectiveness of Contractor phase-in at contract start

Overall Management performance

SCHEDULE PERFORMANCE

Content, accuracy, quality, and timeliness of technical, management, and financial reports and deliverables

Identifies and corrects performance deficiencies in a timely manner

Effective processing of task orders and/or contract changes

Overall Schedule performance

COST PERFORMANCE

Adheres to negotiated estimated costs and contract cost targets

Effectively forecasts and controls costs

Provides accurate and timely financial reporting

Overall Cost performance

Please explain any Marginal (M) or Unsatisfactory (U) ratings notated in the above table: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

NEMCON ATTACHMENT L-01 80KSC019R0019-DRAFT

GENERAL CONTRACT INFORMATION

(a) Contract Value:

Initial Estimated Cost: Initial Fee/Profit: Initial Total Value:

Current/Final Estimated Cost: Current/Final Fee/Profit: Current/Final Total Value:

Briefly describe any change(s) from original contract value:

If yes, what was the magnitude? Please explain:

(c) If an award/incentive fee type contract, percent of available fee earned (percent)?

If yes, please explain the reason for termination (i.e., inability to meet cost or delivery schedules, performance, etc.):

(e) Approximately how many people were/are employed under this contract?

(f) Did any accidents or industrial illnesses resulting in lost time occur under this contract?

If yes, please provide details:

Please explain: