A 03.pdf

418th CSB QASP Vs-202109 1

Joint Modernization Command

Rental/Lease of Tables and Chairs

Project Convergence-Capstone Five (PCC5)

Fort Irwin, California

Quality Assurance Surveillance Plan

As of 11 June 2024

418th CSB QASP Vs-202109 2

This plan is provided for information purposes only. This Quality Assurance Surveillance Plan (QASP) is not part of the solicitation, nor will it be made a part of any resulting contract. The QASP is a government only document and should at no time be provided to the Contractor. The Government has the right to change or modify inspection methods at its discretion.

Table of Contents

1. OVERVIEW

2. DESCRIPTION OF SERVICES

3. ROLES AND RESPONSIBILITIES

4. CONTRACT QUALITY REQUIREMENTS

5. GOVERNMENT SURVIELLANCE

6. NON-CONFORMING PERFORMANCE

7. DATA ANALYSIS

8. ACCEPTANCE OF SERVICES

9. COR MONTHLY STATUS REPORT

10. SERVICE CONTRACT REPORTING (SCR)

11. QUALITY ASSURANCE SURVEILLANCE FILE

12. CONTRACTOR PERFORMANCE ASSESSMENT REPORTING SYSTEM (CPARS)

13. RECORD RETENTION

14. QASP CHANGES

15. COMBATING TRAFFICKING IN PERSONS (CTIP)

16. ATTACHMENTS

418th CSB QASP Vs-202109 3

1. OVERVIEW

1.1 Purpose. The purpose of this plan is to identify the methods and procedures the Government will use to ensure it receives the services/products under this contract as identified in the Performance Work Statement (PWS).

1.2 Intent. The intent of this plan is to hold the Contractor accountable for quality control and to encourage the contractor to take appropriate steps to control and improve quality. The Contractor is responsible to develop an efficient methodology to ensure they meet and/or exceed the required thresholds of service as outlined in this acquisition. The Government intends to perform surveillance on this contract in accordance with this Quality Assurance Surveillance Plan (QASP) but reserves the right to monitor the contract in any manner necessary, at any times necessary, and at all places necessary to ensure that the rendered services conform to contract requirements. The Government reserves the right to perform quality assurance at the subcontract level and perform quality assurance at the contractor's place of business, if applicable. Non-conforming services discovered with subcontractors will be addressed with the prime contractor for resolution.

2. DESCRIPTION OF SERVICES

2.1 Scope of Work. The Contractor shall provide the appropriate amounts of qualified labor and management necessary to perform quality services ordered under contract in a cost effective, safe, and environmentally sound manner for rental/lease of tables and chairs to support Project Convergence-Capstone Five (PCC5) exercise. The Contractor shall comply with all applicable laws and regulations, including but not limited to Federal Law, Texas State Law, Occupational Safety and Health Administration (OSHA) regulations, Army, and installation regulations.

2.2 Contract. The Government will award a Firm Fixed Price (FFP) Contract.

3. ROLES AND RESPONSIBILITIES.

3.1 Government.

3.1.1 Contracting Officer (KO) - A person duly appointed with the authority to enter into, administer and terminate contracts on behalf of the Government. The KO is the only person who can legally commit the Government and only the KO, as the Government’s agent, can modify the contract/order. The KO is the final authority for determining the adequacy of the Contractor’s performance. KO decisions arising under or relating to the contact are final.

Contracting Officer: TBD

Contracting Officer’s Representative (COR) – An individual designated in writing by the KO to perform specific technical and administrative functions within the scope and limitations of their written appointment (e.g., surveillance of Contractor’s performance, accept services). The COR monitors all technical aspects of the contract and assists in contract administration and is

418th CSB QASP Vs-202109 4 authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of Government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates.

The COR is not empowered to make contractual commitments or authorize changes to the order/contract or in any way obligate additional funds by the Government, such authority rests solely with the KO. In the event the contract/order has multiple CORs, the CORs shall work together to ensure oversight is documented and reported.

3.1.3 Contract Specialist: The official Government representative delegated authority by the Contracting Officer to administer a contract. This individual is normally a member of the appropriate Contracting/Procurement career field and advises on all technical contractual matters.

Contract Specialist: TBD

3.2 Contractor.

3.2.1 Program Manager. Responsible for running complex programs and projects. Supervises the project team and manages conflicts within different departments. Plans and sets project goals and milestones and develops risk management strategies. Defines resources and schedules for the implementation of the program. Clearly defines requirements and sets targets accordingly.

Recognizes areas for internal improvement and develops plans for implementing the improvements. The Contractor shall provide in writing a contract manager and alternate to the Contracting Officer within seven (7) days calendar days after contract award, thereafter any changes shall be provided five (5) business days prior to expected changes and no later than 24-hours after unplanned changes

4. CONTRACT QUALITY REQUIREMENTS

4.1. Quality Control Program. The Contractor's Quality Control Program requirements are defined in Part 1.13 of the PWS. The Contractor shall develop, maintain, enforce, and document a Quality Control Plan (QCP) which complies with the requirements of this contract and outlines how they will ensure the Government will receive all the services required by the contract at the specified quality level.

4.2. Government Quality Assurance. The Government will perform Quality Assurance oversight of the Contractor and Contractor’s QCP IAW with this QASP to ensure acceptable levels of contract performance are achieved and that the contractor is performing acceptable levels of Quality Control to ensure fully acceptable services are provided.

418th CSB QASP Vs-202109 5

5. GOVERNMENT SURVIELLANCE

5.1. Methods of Surveillance include but are not limited to:

• 100% Inspection - Reserved for the highest risk areas where consequence of failure is high (i.e. life or limb are threatened) or there is likelihood of mission failure.

• Random Sampling - When a service is performed relatively frequently, and a statistically valid sample can be selected for audit. The most appropriate method for frequently recurring tasks.

• Periodic Sampling - Planned sampling of a service at specific predetermined dates and times. May be appropriate for tasks that occur infrequently.

• Customer Feedback – Not necessarily a valid method of surveillance, but a good indicator for areas surveillance should be conducted or intensified. Must be validated to ensure whether complaint is a compliancy finding or an un-founded complaint.

The method(s) of surveillance utilized for the surveillance of this contract is/are: Random as outlined in 4.0 Performance Requirement Summary of the PWS.

5.2. Monthly Surveillance Schedule. The COR will develop a monthly schedule of surveillance activities based on the Performance Standards as outlined in the Performance Requirements Summary (PRS) will be an attachment to this QASP) as well as any other critical contractual requirements determined to be higher risk requiring oversight. The surveillance outlined in the monthly schedule will be as detailed and in-depth as necessary to provide the Government with the objective quality evidence required to support acceptance of the services provided by the Contractor. The schedule will provide planned periodic surveillance during all required hours of the Contractor’s operation. The schedule is “FOR OFFICIAL USE ONLY” and is not releasable to anyone other than authorized Government personnel. The schedule will identify the method of surveillance, the date of inspection, place of inspection, activity to be monitored, and who will conduct the surveillance (dates and times can be altered without a formal change to the schedule as long as all inspections are performed). The 418th CSB surveillance schedule may be used to plan and schedule monthly surveillance, a local schedule developed by the COR, or the SPM surveillance schedule Smart form. The monthly schedule will be completed no later than seven

(7) calendar days prior to the beginning of the period it covers, and a copy uploaded into the COR’s online record.

5.3. Inspection instructions/checklists. The COR will develop inspection instructions/checklists for all planned inspections which may require special instructions on how to perform the inspection and what observations should be made with specific details of what to look for to indicate acceptable performance.

The following are acceptable surveillance checklist methods:

418th CSB Inspection Checklist SPM Inspection Checklist Smart form COR’s own developed Surveillance Checklist - must meet criteria in paragraph 5.4.

5.4. Documentation of Inspections. All inspections/observations shall be documented and will include at a minimum: date and time, who performed the inspection, what was inspected, to what

418th CSB QASP Vs-202109 6 standard, and the results. The PWS paragraph shall be cited in each inspection task. Successful or exceptional performance will be documented as well as deficiencies in contractor performance.

Documentation will be maintained for future reference, audit, proof of inspection, and past performance documentation.

6. NON-CONFORMING PERFORMANCE. The COR will notify the Contractor, in person, each time an unacceptable observation has been recorded and ask the Contractor to correct the problem or re-accomplish the service. All valid non-conformances observed by the Government will be documented! The COR will record the contract requirement, the specific deficiency to the requirement, the date and time it was discovered, and have the Contractor initial the entry. The Contractor will be provided a timeline after notification to correct the deficiency in accordance with the requirements of the contract. Deficiencies that cannot be corrected within the identified timeline will be reported to the KO. The 418th CSB corrective action request (CAR) worksheet shall be used to document all contractual nonconformances to include issues.

All CARs shall be logged into the CAR Log by the QAS. Only KOs shall issue CARs to the contractor.

6.1. Customer Feedback. For customer feedback or complaints, it is recommended that a Customer Complaint Form be used. However, customer feedback can be in any form, verbal or written but no matter the format the COR will maintain a record of the feedback; positive or negative.

a. If immediate response to a complaint is required, the COR will provide the response to the requester as soon as practical.

b. The COR will conduct an investigation to determine the validity of any negative comments received.

c. If the negative comment is determined not to be valid, if possible, the COR will inform customer of the reason(s) as soon as practical.

d. For validated negative comments that are true contractual non-conformances see paragraph 6.

If this non-conformance is a more serious (systemic in nature) deficiency or recurring deficiency that could indicate a trend the COR should see paragraph 6.2.

e. The COR will follow up with the customer of the corrective action taken by the contractor, if applicable.

6.2. Corrective Action Request (CAR). The COR will report serious (systemic in nature) deficiencies or recurring deficiencies that could indicate a trend by using the 418th CSB corrective action request worksheet. The corrective action request will state the Contract Requirement, the specific contract reference, and the specific violation (s) to the requirement. The COR will forward copies of corrective action request to the QAS within one (1) working day for review and CAR control number assignment. The QAS will forward the CAR to the KO for review and/or issuance. The KO will notify the Contractor and request corrective action to the specific non-conformance, identification of the root cause, and corrective action for the root cause with a required suspense date. The KO may require the Contractor to re-perform any services that do not

418th CSB QASP Vs-202109 7 meet contract requirements at no additional cost to the Government. The Contractor will return a copy of the completed and signed corrective action request along with their Corrective Action Plan (CAP) to the COR for review, approval, and inclusion in the contract/order file. The COR should include the KO in the review of the CAP and re-inspection of services that were found deficient to ensure the CAP included adequate root cause analysis, corrective action for the root cause and that it was accomplished in the timeframe agreed upon. The KO and COR will not consider the CAR closed until all deficiencies have been corrected and all agreed upon actions of the CAP have been completed. Contractor’s failure to follow through and complete corrective actions will be reported immediately to the KO for further action. (Note: if the COR has to repeatedly perform re-inspection there could be a Government re-inspection cost which could be recovered from the Contractor). The COR will also follow-up after the Contractor has completed the corrective action to ensure that the Contractor’s corrective action was sufficient to preclude recurrence. Inclusion of the QAS is required for all CAR correspondence for traceability and tracking.

6.2.1 Tracking and Resolving CARs. All CARs will be included in the COR’s Monthly Status Report. The COR, QAS, and KO shall track CARs to ensure the Contractor identifies and takes appropriate corrective action to the root cause and the specific non-conformance is corrected within the required timeline. The KO will make a final written determination of the Government’s remedies if the non-conformance is not corrected by the Contractor after receiving notice and a reasonable opportunity to correct the work.

7. DATA ANALYSIS. The COR shall perform and document analysis of available data monthly and make adjustments to surveillance schedule as required based on results of analysis. Analysis shall be used to look for and document trends in performance which may indicate shifts in performance risk that could result in increased or reduced surveillance. Data can be based on Government observations or Contractor observations. Negative trends noted using Government observations could result in issuing Contractor a corrective action request (CAR). Trends noted using Contractor data should never result in a CAR unless the Contractor is not addressing the negative trend. Documentation of data analysis will be communicated in the Monthly COR Status Report.

8. ACCEPTANCE OF SERVICES. When all services have been deemed acceptable and there is documented objective quality evidence to support acceptable performance in the COR’s file, the COR will accept the services provided and authorize payment upon satisfactory completion of the work. This is accomplished by approving the Contractor’s invoice in the Wide Area Workflow module at https://piee.eb.mil/.

9. COR MONTHLY STATUS REPORT. No later than the 10th day of each month, the COR will complete the COR Status Report for KO review and acceptance or rejection. The COR will use the criteria listed below when rating the Contactor’s Quality of Work in the status report. This rating will be based on the COR’s performed inspections during the month’s surveillance. If the Contractor has scored 95% and above on the 418th CSB Inspection Checklist, they are considered to be meeting the requirements of the contract. An inspection score equal to or below 94% needs to be rated accordingly (Marginal or Unsatisfactory) dependent on the number of identified discrepancies found during the surveillance.

https://piee.eb.mil/

418th CSB QASP Vs-202109 8

Contractor’s Quality Of Work Contractor quality of work ratings and criteria are described below:

Performance Rating

Criteria

Exceptional Performance meets contractual requirements and exceeds many of the government’s benefits. 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 were highly effective.

Very Good Performance meets contractual requirements and exceeds some of the government benefits. The contractual performance element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were highly effective.

Satisfactory Performance meets all minimum 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.

Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed 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.

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

In the event there is no contractor performance to observe for the month, the COR is REQUIRED to submit a COR Status Report indicating the following: “No reported surveillance for month xxx due to no contractor performance”.

The COR Status Report shall be filled out in its entirety based on the submitted surveillance for the month to include surveillance checklist, surveillance schedule, contractor deliverables, CAR’s (if applicable). The COR shall ensure all information annotated in the COR Status Report is current, valid, and supplemented by objective evidence in the COR’s online file. This includes the number of Contractor employees currently on the contract (if applicable).

418th CSB QASP Vs-202109 9

10. SERVICE CONTRACT REPORTING (SCR). If the KO has designated service contract reporting as the COR’s responsibility, the COR shall verify that the Contactor has complied with the required contractor manpower reporting no later than 31 Oct for the previous FY. The COR shall identify and document observations of compliance in their November COR Status Report.

The COR shall upload a copy of the service contract report or a screenshot of contractor submission in their online file providing evidence of contractor submission and COR validation.

11. QUALITY ASSURANCE SURVEILLANCE FILE. The official COR Surveillance File will be maintained in the on-line PIEE SPM File per ACC PAM 70-1 and DFARS. The COR Surveillance file shall contain the following as applicable:

a. Copy of the COR designation letter from the KO, any changes to that letter, and any termination letters.

b. Training Certifications for COR and refresher training.

c. Copy of the applicable Quality Assurance Surveillance Plan (QASP).

d. Copy of the contractor’s Quality Control Plan (QCP)

e. All correspondence initiated by authorized representatives (Contractor or Government) concerning performance of the contract.

f. Names, position titles and contact information of all key personnel assigned to this contract both Government and Contractor.

g. Monthly surveillance schedules.

h. Surveillance Checklists

i. Records of all inspections performed and the results.

j. Customer Feedback.

k. Memoranda for record of minutes of any meeting, telephone conversations and discussions with the contractor or others pertaining to the contract or contract performance.

l. Documentation pertaining to tracking expenditures/receipts (i.e., T&M & Cost CLIN items).

m. All PWS-required deliverables if not provided to the KO.

12. CONTRACTOR PERFORMANCE ASSESSMENT REPORTING SYSTEM (CPARS).

If the COR is designated the responsibility of CPARS - documented surveillance data IAW this QASP will be used as objective data to support CPARS ratings. The inclusion of detailed documented inspection results provides objectivity to CPARS reporting. CPARS will be accomplished annually or at the end of a Task Order, whichever occurs first.

418th CSB QASP Vs-202109 10

13. RECORD RETENTION. All records will be retained for the life of this contract. The COR shall ensure all records are uploaded into their online file and all hard copies will be forwarded to the KO upon completion of the contract/order.

14. QASP CHANGES. The QASP is a living document and, as such, may be changed as needed.

However, the KO/KS must approve changes. The COR will submit recommended changes to the KO/KS for approval. Once approved, the COR will upload the newest version into their online file.

15. COMBATING TRAFFICKING IN PERSONS (CTIP). Tier 1 Locations, Contracting Officer Representative (COR) shall ensure contractor are in compliance with FAR 52.222-50. For Tiers 2, 2 watch list (WL), and 3 locations, CORs shall ensure contractors are in compliance with tier 1 requirements but also will perform spot checks, reviews, assess, and speak with government representatives, contractor, and subcontractor employees to assess if there are indicators of CTIP.

If indicators are identified, notify the contracting officer immediately. CTIP surveillance reporting are completed biannual, CTIP surveillance information shall be submitted to the contracting officer NLT the last working day of June and NLT the last working day in November.

418th CSB QASP Vs-202109 11

16. ATTACHMENTS

ATTACHMENT 1.

Performance Requirements Table The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

Program Objectives Standard Performance

Threshold Method of

Surveillance Para 5.1- 5.7, 5.9 Deliver tables and chairs IAW product specifications

- Correct # delivered and setup

- Delivered and setup tables and chairs when and where requested

- Delivered and setup tables and chairs at the designated locations

- 100 % Coverage throughout rental terms

- No Deviations

- 100 % Inspection

- Customer Complaints

Para 5.8, 5.9.2 Removal of tables and chairs

- Correct # of pickup when requested

-No delivery or installation debris remaining at location sites

- 100 % Inspection

- Customer Complaints

The Contractor shall Notify its employees of the United States Government's zero tolerance policy described in paragraph of this clause.

The actions that will be taken against employees for violations of this policy. Such actions may include, but are not limited to, removal from the contract, reduction in benefits, or termination of employment.

Combating Trafficking in Persons

FAR 52.222-50c

100% Compliance - 100 % Inspection

418th CSB QASP Vs-202109 12

IMBEDDED ATTACHMENTS:

ATTACHMENT 2. Customer Complaint Record

Customer Complaint Record Template.docx

ATTACHMENT 3. Surveillance Schedule Template

418th Surveillance Schedule.xlsx

ATTACHMENT 4. Surveillance Checklist Template

418th Inspection Checklist.xlsx

ATTACHMENT 5. MICC Corrective Action Request Form 3

Corrective Action Request

CUSTOMER COMPLAINT RECORD

DATE OF COMPLAINT

TIME OF COMPLAINT

ORGANIZATION SOURCE OF COMPLAINT

INDIVIDUAL

NATURE OF COMPLAINT

CONTRACT REFERENCE

VALIDATION

DATE CONTRACTOR INFORMED COMPLAINT

(Responsible officer)

TIME CONTRACTOR INFORMED OF COMPLAINT

(Responsible officer)

ACTION TAKEN BY CONTRACTOR (Responsible officer)

RECEIVED AND VALIDATED BY

418th CSB Customer Complaint Record Template

QASS Instructions

Instructions for Completing the Quality Assurance Surveillance Schedule

1 Contract Number: Insert your contract number into the gray shaded area.

2 Contractor: Insert the contractors company name into the gray shaded area.

3 Type Service: Insert the type of service provided into the gray shaded area.

4 COR Name: Insert your name into the gray shaded area.

5 Month: Insert the surveillance month into the gray shaded area.

6 Date Submitted: Insert the date you submit the QASS into the Contracting Officer Representative Tracker (CORT) web application into the gray shaded area.

7 Week 1/2/3/4 Date: Insert the actual surveillance date for the week into the gray shaded area.

8 Location Insert the physical location (i.e. post name and building number) the surveillance took place into the gray shaded area.

9 Time of Day Insert the time of day the surveillance took place into the gray shaded area.

10/11 Process Audit/Checklist Insert an X for either process audit or checklist inspection performed into the gray shaded area, in the coresponding column.

12 Remarks Insert any remarks or comments into the gray shaded area related to the process audit or checklist inspection.

OCT

(Name) QUALITY ASSURANCE SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

NOV

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

DEC

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

JAN

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

FEB

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

MAR

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

APR

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

MAY

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

JUN

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

JUL

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

AUG

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

SEP

(Name) COR SURVEILLANCE SCHEDULE

1. Contract Number: 4. COR Name:

2. Contractor: 5. Month:

3. Type Service: 6. Date Submitted:

7. Week 1 Date: 7. Week 2 Date: 7. Week 3 Date: 7. Week 4 Date:

8. Location: 8. Location: 8. Location: 8. Location:

9. Time of Day: 9. Time of Day: 9. Time of Day: 9. Time of Day:

10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist 10. Process Audit 11. Checklist

12. Remarks 12. Remarks 12. Remarks 12. Remarks

Surveillance Checklist

SURVEILLANCE CHECKLIST

COR Inspection Checklist & Data Report (Firm-Fixed Price Contract)

SECTION 1 - GENERAL CONTRACT INFORMATION

Contract Description: Insert contract service(s) name (i.e., Custodial Services, Grounds Maintenance, etc.)

Contract Requirement: The Contractor shall … [This should be the Scope of Work copied & paste from the PWS/SOW]

Inspector's Instructions: Complete this checklist to evaluate the Contractor's performance during the rated period. The inspection checklist shall be completed and submitted into the COR's online file to substantiate the Contractor's Quality of Work Rating for the month's surveillance. Include PWS para and what was actually observed.

Contract Number: XXXXXX-XX-X-XXXX Surveillance Date: 28-Jul-2021

Task/Delivery Order: N/A PoP End Date: 31-Dec-2021

Contractor Name: Insert Name of Contractor Company CAGE Code: 12AB0

Contracting Officer Name: Insert Contracting Officer's Name Location: Fort XYZ, XX

COR Name: Insert COR's Name Facility Number: Building 0000

Supervisor Name: Insert COR's Supervisor Name Start Time: 1:00 PM

Command: Insert Command (i.e., IMCOM) End Time: 1:45 PM

Directorate/Military Unit: Insert Directorate (i.e., USAG) Agency/Department: DPW-QA

Contractor Rep. Notified: Insert Name of Contractor's Rep. Notified Revision Number: Revision 1

Surveillance Frequency: Weekly Revision Date: 28-Jul-2021

Surveillance Method(s): Insert Method (i.e., Random Sampling) QASP Reference: Insert Para. #

SECTION 2 - RATING CRITERIA

RATING CRITERIA 0.0% Unsatisfactory 1

Rating Area Max Points Points Weight % Raw LOP % Scoring Rating CPARS

Demand Maintenance Orders 21 0 0.899 0.00% 0.0% 100% Exceptional 5

Additional Rating - Very Good 1 0 0.050 0.00% 0.0% 90 - 99.9% Very Good 4

Additional Rating - Exceptional 1 0 0.051 0.00% 0.0% 80 - 89.9% Satisfactory 3

Max Points Points Weight Base% 70 - 79.9% Marginal 2

Overall Rating 23 0 1.00 0.0% 0 - 69.9% Unsatisfactory 1

SECTION 3 - SURVEILLANCE QUESTIONS SECTION 4 SECTION 5

Contract Service XXX 0 0 0

DID THE CONTRACTOR MEET THE CONTRACT REQUIREMENT(S)? YES NO OBSERVED

1. To populate the checklist, find in the PWS: "The Contractor shall...”, then make that requirement a checklist item by converting it to a question: “Did the contractor…"? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

Comments:

2. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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3. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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4. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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5. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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6. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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7. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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8. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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9. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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10. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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11. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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12. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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13. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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14. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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15. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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16. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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17. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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18. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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19. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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20. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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21. Did the Contractor …..? (STD: The Contractor shall ...) PWS Para. 0.0 Yes or No Yes or No

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SECTION 6 - ADDITIONAL RATING

ADDITIONAL RATING OF VERY GOOD 0 0

Did the Contractor performance justify a Very Good rating? If so, identify a significant event and state how it was a benefit to the Government. There should have been no significant weaknesses identified. Note: There must be objective evidence in the online file to support a “Very Good” rating. No Yes or No

Comments:

ADDITIONAL RATING OF EXCEPTIONAL 0 0

Did the Contractor performance justify an Exceptional rating? If so, identify multiple significant events and state how they were of benefit to the Government. 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. Note: There must be objective evidence in the online file to support an “Exceptional” rating. No Yes or No

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SECTION 7 - SUMMARY

SUMMARY / ADDITIONAL REMARKS

Provide a brief synopsis of inspection points and results. Highlight issues or concerns found during the surveillance period. Communicate clearly to the KO/CS what was objectively found during surveillance and what rating the contractor's performance is assessed at. *Remember, if contractor is meeting the requirement, the rating will always be "Satisfactory". The more rationale and substantiating evidence you have supporting your inspection results the better the overall performance evaluation will be.

This information will be copy/paste into the COR Status Report and will assist with developing CPARS input.

SECTION 8 - NONCONFORMANCE REPORTING

Nonconformance Report (NCR) Worksheet Required? (Required if, atleast, one checklist item is marked "No") No

SECTION 9 - SIGNATURE(S)

Contractor Representative's Signature:

Inspector's Signature:

SECTION 10 - PROCEDURAL / INSTRUCTIONAL GUIDANCE

SURVEILLANCE CHECKLIST PROCEDURES

The Contracting Officer's Representative (COR)/ Alternate Contracting Officer's Representative (ACOR)/ Quality Assurance Evaluator (QAE) shall provide inspection results using the surveillance checklist. All questions on the surveillance checklist shall be completed prior to submission in SPM. If the Contractor (KTR) has performed a contract requirement (represented by the question) to the contract standard, "Yes" will be selected next to the corresponding question. If the KTR did not perform to the contract standard, select "No". If "No" is selected, it must be it must be validated as a non-conformance and a Non-conformance Report (NCR) Worksheet will be initiated. If a question does not apply or it was NOT OBSERVED, in the "Observed" block, select "No", then "N/O" (not observed), in this case the requirement for that inspection point will not be rated. In the COMMENTS field following each question, provide a reason the question was not observed or does not apply during the surveillance period.

Upon completion of the surveillance, a brief summary of the surveillance shall be annotated in the SUMMARY/ADDITIONAL REMARKS field. This information shall be copied and paste into the COR Status Report via Surveillance Performance and Monitoring (SPM) Module each month. Next convert the checklist to PDF and electronically sign prior to uploading into the COR Documents Section of the online file. The KO/

CS will review the checklist for substantiating evidence in order to approve the submitted COR Status Report. The Quality Assuarance

Specialist (QAS) shall audit the surveillance checklist for completeness, accuracy and validation of non-conformance occurances.

PERFORMANCE RATING SYSTEM

Rate Contractor's quality of work observed to conclude whether the Contractor was, or was not, in compliance with the requirement.

Quantitative and objective data, as well as references, will be provided when applicable. Objective scoring is based on "Yes" or "No" responses to the questions. The checklist contains formulas which will calculate the level of performance and produce a numerical value consistent with the Contractor Performance Assessment System (CPARS) rating scheme IAW FAR 42.1503, Table 42-1 - Evaluation Rating Definitions.

Overall performance of the service will be rated in accordance with a five scale rating system (i.e., Exceptional, Very Good, Satisfactory, Marginal, and Unsatisfactory) on the date evaluated. The overall rating and narrative(s) must reflect the definitions shown in the "Rating

Descriptions" section of the surveillance checklist.

NON-CONFORMING PERFORMANCE

When atleast one checklist item is marked "No", a NCR Worksheet must be intiated by the COR/ACOR. Each annotated non-compliance requirement will be included on the NCR worksheet. Checklist items marked "No" must include details of the non-compliance, to include the associated Performance Work Statement (PWS) requirement reference.

All deficient (Marginal or Unsatisfactory) ratings must be documented on the surveillance checklist and the Contractor must be notified. Upon completion of the surveillance inspection, the Contractor's Representative will be provided a copy to acknowledge the deficiencies. The contractor will sign in the blank field adjacent to "Contractor Rep. Notified". The acknowledgement is not intended to indicate agreement with the evaluation findings, but to serve as documented evidence that the contractor was notified at the time of inspection. Further contractor may be required.

RATING DESCRIPTIONS (IAW FAR 42.1503, TABLE 42-1 - EVALUATION RATING DEFINITIONS)

Exceptional - Performance meets contractual requirements and exceeds many to the government’s benefits. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems and contractor actions were highly effective.

Very Good - Performance meets contractual requirements and exceeds some to the government benefits. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory - Performance meets contractual requirements. The contractual performance contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Marginal - Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear marginally effective or were not fully implemented.

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

Page &P of &N

No

Contract Number:

Task/Delivery Order :

Contractor required to have Quality Management and/or Quality Control Plan? Yes

Commercial Contract Yes No

Command

Organization

DODAAC of Office who will issue CAR to Contractor

Program Name

Contact Information for Individual who Identified Nonconformance Name: Position:

E-mail address

Phone number

Contact Information for Individual Reviewing Nonconformance

Phone number:

Contact Information for Individual to Issue Nonconformance (KO)

Phone number:

Nonconformance Rating:

Name of Contractor:

Point of Contact (POC) at Contractor:

Contractor POC Title (position):

Contractor POC E-Mail Address

Contractor Phone:

Office

* If more than 1 NC reported select highest Level.

Name: Position:

Position: Name:

Contractor CAGE:

CORRECTIVE ACTION REQUEST (CAR) FORM

Version_1_202402

Date Non-Compliance Observed:

Non-Compliance Rating:

Non-Compliance Description:

Place check mark if Attachments will be included:

Deficiency Number:

Contractual Requirement:

Non-Compliance Information

Complete the below fields to describe the observed nonconformance. If multiple discrepancies are identified, click "Add Noncompliance". If providing attachments as supplemental evidence, ensure to provide the CAR & the Attachments to the Quality Assurance Specialist for review and inclusion to the Contracting Officer.

Delivery Schedule Impact Possible:

Repeat Finding:

Blank Page

DODAAC of Office who will issue Nonconformance to Contractor:

Contracting Command: []

Contracting Organization: []

Contract Number:

TO/DO:

Group16: Off

Group17: Off

Contract Name / Service Description:

Position:

Email1:

Phone Number 1:

Phone Number 2:

Phone Number 3:

Position2:

Position3:

Email2:

Email3:

Contractor CAGE:

Contractor Name:

Contractor POC:

Title:

KTR Email:

Contractor Phone:

Nonconformance Rating/Level: []

Contracting Office:

Originator Name:

Reviewer Name:

KO Name:

Add Noncompliance:

Clear Form:

Attachments: Off

Save:

Button1:

NC #:

Repeat Finding: []

Repeat Finding1: []

Schedule Impact: []

Schedule Impact1: []

Date NC Observed2:

Nonconformance Rating2: []

NC Descriptionpg1:

Contractual Requirementpg1:

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Date NC Observed1:

Nonconformance Rating1: []

P2:

Add1:

Date NC Observed2:

Nonconformance Rating2: []

NC Descriptionpg1:

Contractual Requirementpg1:

Attachments: Off

Add Noncompliance:

Save:

Button1:

NC #:

Repeat Finding1: []

Schedule Impact1: []

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P3:

Add1:

Date NC Observed2:

Nonconformance Rating2: []

NC Descriptionpg1:

Contractual Requirementpg1:

Attachments: Off

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Button1:

NC #:

Repeat Finding1: []

Schedule Impact1: []

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