Attachment (12) Past Performance Questionnaire (PPQ).doc

N00024-16-R-3208

Solicitation No. N6449823R4003

The Naval Surface Warfare Center Philadelphia Division (NSWCPD)

Bldg 77H Fuel Pump Controller Repairs

Attachment 12 Past Performance Questionnaire

The Contractor shall complete the company specific information on this form for past performance project examples that the Contractor will be providing, contact their clients, forward this form to their clients and request that their clients complete it and send it via email to the listed individual before the closing time for receipt of offers: Linda M. Dobbs; linda.m.dobbs2.civ@us.navy.mil and Edward D’Imperio; edward.r.dimperio.civ@us.navy.mil. This will expedite the response from each referenced source.

Please title the subject line of the e-mail to read “SOLICITATION NO. N6449823R4003 – Past Performance Questionnaire” *NOTE: IT IS THE RESPONSIBILITY OF THE OFFEROR TO ENSURE ALL PAST PERFORMANCE QUESTIONNAIRES ARE SUBMITTED TO THE GOVERNMENT BY THE CLOSING DATE AND TIME.

If you need more space than that provided, please attach additional pages. Responses will be treated as source selection sensitive information. If you have any questions, please contact the Contracting Officer at the above e-mail addresses.

1. Contract Information (Note: The CONTRACTOR SHALL COMPLETE THIS SECTION)

a) Contractor Name: ______________________________________________________________

b) Contract Number: ______________________________________________________________

c) Performed as Prime or Subcontractor (Circle or Highlight): PRIME SUBCONTRACTOR

d) Describe your role as Prime or Subcontractor under this effort: _______________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

e) Total period of performance (Start/Completion date; month and year):

f) Total Contract Dollar Amount at Completion (or Current Contract Dollar Amount, if not Completed:___________________________________________________________________ g) Describe Project Location (town, city, state, building name, or building number, etc.): ______________________________________________________________________________

h) Describe the Project and Services provided. Provide any relevant information in regards to

Fuel Pump Control System Repairs. For example, the types, sizes, etc.:

i) Contract Type (FFP, Labor Hour, Time & Materials; Cost Reimbursement (CPFF, CPIF, CPAF, etc.): ___________________________________________________________________

CONTRACT ASSESSMENT

2. Contract Relevancy. For comparison with the size and scope of this acquisition, please provide the following information pertaining to the contract identified in Section 1 above.

Project Management Fuel Pump Control System Repair

Remove/Replace all power and control wiring

Provide New Conduit Pathways

Quality Control Acquisition and Contract Management Support

Technical Expertise

Other Support (please describe:_________________________________________)

3. Performance Assessment Values (Please Circle or Highlight Rating # 1-5 for examples below) 5 - Exceptional. Performance meets contractual requirements and exceeds many to the client’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.

4 – Very Good. Performance meets contractual requirements and exceeds some to the client’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.

3 - Satisfactory. 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.

2. – Marginal. 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.

1 - 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 a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

0 - Not Applicable. Unable to provide a score. Performance in this area not applicable to effort assessed.

4. Assessment Elements. Please select/circle the appropriate performance assessment value for each item on the questionnaire and provide supporting narrative.

a. Overall Technical Performance. 5 4 3 2 1 0 Comments:

b. Delivered according to Schedule. 5 4 3 2 1 0 Comments:

c. Level of Quality Received. 5 4 3 2 1 0 Comments:

d.

Safety Environment. 5 4 3 2 1 0

Comments:

e. Coordination of outages with facility’s needs. 5 4 3 2 1 0 Comments:

f. Proactive to Potential Risks. 5 4 3 2 1 0 Comments:

g. Compliance with Security Requirements. 5 4 3 2 1 0 Comments:

h. Recommendation. To what extent would you recommend this contractor for additional contracts? Circle below

5 = Yes, definitely; 4 = Yes, likely; 3 = Maybe, 2 = No, not likely; 1 = No, not ever; 0 = N/A.

Comments:

5. Other References. If you are aware of any other contract or a Point of Contact (POC) who is familiar with the contractor’s performance under this contract, please identify.

Name, Phone, and E-Mail Address:

6. Assessor Information. Assessors shall provide the following information about yourself:

Name:

Title:

Address:

Phone Number:

E-Mail Address:

Thank you for your assistance.

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