Attachment 2 Past Performance Questionnaire (PPQ).pdf

RFP No. 80LaRC25R7001 Attachment 2, Past Performance Questionnaire (PPQ)

This questionnaire contains Source Selection Information when completed. See FAR 2.101 & 3.104

NASA Langley Research Center

Joint Safety Health Institutional Facilities Team (JSHIFT)

INSTRUCTIONS TO COMPLETE QUESTIONNAIRE

Send the completed questionnaire directly to the NASA Contracting Officer Lisa Harvey at the email address below (do not return to the Offeror):

Lisa Harvey, by Adobe PDF file to: larc-jshift@mail.nasa.gov

This form contains Source Selection Information when completed-See FAR 2.101 & 3.104 Solicitation No. 80LARC25R7001

Section I – Contract Information: Fill in Contract Info/Company being evaluated and the contract information. For contract type check all that apply to the contract being evaluated.

Sections II Evaluators that completed that completed questionnaire: Fill in name(s), title(s), agency/organization(s), email address(s), phone number(s), role in contract, and date completed. If possible, ensure the questionnaire is jointly completed by the Technical Customer (PM, COR, QAE) and Contracting Officer (CO).

Section III, Performance Ratings & Amount of Worked Performed: Indicate responses for both “Performance” and “Relevance/Amount of Work Performed” for each Performance Work Statement (PWS) area. Excerpts of the relevant paragraphs from the PWS are attached entitled, “Performance Work Statement (PWS) Area Detailed Paragraph References”.

Use the ratings below to assign a performance rating for each of the questions. The definitions of each rating are provided in the Evaluation Ratings Definitions found in FAR 42.1503(h)(4).

• Exceptional (E)

• Very Good (VG)

• Satisfactory (S)

• Marginal (M)

• Unsatisfactory (U)

• Not Applicable (NA)

For Section III, in addition to rating performance please rate the amount of work that the contractor performed under your contract in each area assessed using the following ratings:

• Significant Amount (Sig) -- Routinely performed the full range of services for the PWS element(s).

• Moderate Amount (Mod) -- Performed several aspects of the PWS element(s) with moderate frequency.

• Minimal Amount (Min) -- Performed at least some aspects of the PWS element(s), although such performance was limited in scope or frequency.

• Not Applicable (NA) -- Did not perform the PWS element(s) under your contract.

IV General Performance Ratings: Indicate responses for contractor’s performance in general areas using the Evaluation Ratings Definitions found in FAR 42.1053(h)(4).

• Exceptional (E)

• Very Good (VG)

• Satisfactory (S)

• Marginal (M)

• Unsatisfactory (U)

• Not Applicable (NA)

A. Contract Info/Company Being Evaluated and Contract Information:

Company Name (Specific Division) Company Address

Cage Code DUNS number Contract Number Task Order/Delivery Order Number (if applicable) Total Contract Value/Current Contract Value Total Task Order/Delivery Order Value (if applicable) Average Annual Contract Actual Amount (i.e., The current contract actuals/ expenditures to date divided by the number of years of performance to date):

Period of Performance Start Date: End Date:

Please provide a summary/scope of the Work Performed by the company identified above. If available, please attach the SOW/PWS or other requirements document that reflects the work the company identified above performed

Award/Incentive Fee (provide ratings that the contractor received over the past 5 years), if applicable

Rating Period #1: Rating:

Rating Period #2: Rating:

Rating Period: Rating:

Rating Period: Rating:

Rating Period: Rating:

Rating Period: Rating:

*Please attach available award fee letters

B. CONTRACT TYPE (“X” all that apply):

Check all that apply: Check all that apply:

Prime Contractor Firm Fixed Price Subcontractor Cost Plus Fixed Fee Joint Venture Partner/Team

Member Cost Plus Award Fee

Other: ___________ Time & Materials Other: _______________

C. INDIVIDUAL(S) COMPLETING THIS FORM: (If possible, please ensure the Technical Customer (PM, COR, QAE) and CO jointly complete/coordinate on the questionnaire.

Name(s) Title(s) Agency/Organization Email Address/ Phone No.

Role in Contract/Date Completed

III. PERFORMANCE RATINGS & AMOUNT OF WORK PERFORMED: Indicate responses with an “X” for the rating chosen for both “Performance” and “Relevance/Amount of Work Performed” for each

Performance Work Statement (PWS) element listed below using the adjective ratings and definitions below:

E = Exceptional, VG = Very Good, S = Satisfactory, M = Marginal, U = Unsatisfactory, N/A = Not Applicable

SIG = Significant, MOD = Moderate, MIN = Minimal, N/A = Not Applicable

PERFORMANCE WORK

STATEMENT AREAS

PERFORMANCE RATINGS

From High o Low

E, VG, S, M, U, NA

(Please Circle One)

RELEVANCE/AMOUNT OF

WORK PERFORMED

From High to Low Sig, Mod, Min, NA

(Please Circle One)

1 Comprehensive occupational safety inspection program of large-scale industrial facilities similar to NASA centers. This includes performing facility inspection per OSHA 29 CFR 1960, Construction, Spot, laboratory, fire safety inspections to identify workplace hazards and recommend controls to protect personnel. (Refer to PWS requirement SIA01).

E VG S M U N/A SIG MOD MIN N/A

2 Test Safety Engineering Program which includes performing reviews and overseeing test operations in various environments such as vacuum chambers, extreme temperatures, underwater, vibration, and zero-gravity to identify workplace hazards and exposures and recommending controls to protect personnel and equipment.

(Refer to PWS requirement

TOSS02).

E

VG S M U N/A SIG MOD MIN N/A

3 Comprehensive Fire Protection Program including performing engineering analysis, inspection, testing, maintenance, repair and operation of fire alarm systems in accordance with NFPA 72, National Fire Alarm Code; NASA STD 8719.11, Safety Standard for Fire Protection or other federal regulation; and associated or applicable standards as well as manufacturer requirements or recommendations, workplace hazards and exposures, and recommending controls to protect personnel. (Refer to PWS requirement FAS01, FPSSG01).

E VG S M U N/A SIG MOD MIN N/A

4 Comprehensive Industrial Hygiene (IH) Program in support of multiple organizations and/or tenants in compliance with OSHA and industry standards. This includes performing IH baseline surveys, identifying workplace hazards and exposures, and recommending controls to protect personnel. (Refer to PWS requirement CIHS01, OEA01, HBM01).

5 Comprehensive Radiation Safety Program including ionizing and non-ionizing sources including managing sources, performing analysis in compliance with OSHA, NRC, and industry standards. (Refer to PWS requirement RPS02, RPS05, LLS01, LLS03, and LLS07).

Please provide comments (use additional sheet(s) if necessary). Any comments must be directly related and clearly traceable to the PWS areas in the chart above.

IV. General Performance Areas: Assess the contractor’s performance in areas identified below.

Additional pages may be used for comments if desired. Please keep in mind that only performance in the past five (5) years is relevant to our procurement. If you cannot answer any questions, please place an “X’ in the Not Applicable (N/A) block.

GENERAL PERFORMANCE AREAS

PERFORMANCE RATING

E, VG, S, M, U, N/A

(Please Select One)

1. Meeting Schedules

E VG S M U N/A

2.

Adaptability to address changing missions/requirements

E VG S M U N/A

3. Management of Personnel

E VG S M U N/A

4. Business Relations

E VG S M U N/A

Rate the contractor’s overall performance under this contract E VG S M U N/A

Performance Work Statement Detailed Paragraph References

PWS AREA 1:

Safety Inspections and Audits (SIA)01-The Contractor shall perform safety inspections in accordance with Center specific requirements per (Addendum, DRD, etc.) Examples of inspections includes facility inspection per OSHA 29 CFR 1960, Construction, Spot, laboratory, fire safety inspections, etc.

PWS AREA 2:

Test Operations Safety Support (TOSS)02- The Contractor shall participate in reviews and monitor the actual tests for test operations. These test operations occur in various environments such as vacuum chambers, extreme temperatures, underwater, vibration, and zero-gravity. The purpose of test safety operations is to prevent personnel injury or unexpected damage to NASA equipment from tests.

PWS AREA 3:

Fire Alarm Systems (FAS)01- The Contractor shall inspect, test, maintain, repair, and operate fire alarm systems to ensure they reliably detect and report events from the device location and alert employees and the emergency dispatch center per the following standards:

NFPA 72, National Fire Alarm Code; NASA STD 8719.11, Safety Standard for Fire Protection; associated or applicable standards; and the manufacturer's requirements and recommendations for inspection, testing, and maintenance for fire alarm systems and the Center’s fire alarm network and dispatching computer systems.

Fire Protection System Services (FPSSG)01- The Contract PWS includes all the Center’s fire alarm and/or suppression systems including but not limited to fire alarm communication networks, dispatch, maintenance, and control computer workstations, building and network related fire alarm panels, circuits, and devices, water and other automatic fire extinguishing systems and manual fire suppression systems.

The contractor shall provide technical experts that have experience and certifications to repair, install, maintain, program, and operate all said equipment and systems. Both the Company and each employee shall be registered / licensed according to the rules and regulations of the state and local jurisdiction and certified as recommended by the equipment manufacturer for all contracted work.

PWS AREA 4:

Comprehensive IH Surveys (CIHS)01- The Contractor shall conduct comprehensive baseline surveys of all centers’ organizations and workplace operations in accordance with center procedural requirements.

Comprehensive Baseline Surveys include, but are not limited to: characterization of operations and their associated health hazards, assessment of risk from health hazards, application of risk assessment to similar exposure groups, measurement and evaluation of chemical hazards (i.e., gases, vapors, dusts, mists, fumes), physical hazards (i.e., noise, vibration, temperature extremes, ergonomics, illumination), biological hazards (i.e., bloodborne pathogens, other potentially infectious material, fungal contaminants), recommendation for engineering, local exhaust ventilation (LEV), administrative, and personal protective equipment (PPE) controls. Employee exposure to carcinogens, extreme toxicants, substances with low occupational exposure limits or high risk of exposure, sensitizers, and developmental/reproductive hazards shall be specifically evaluated for health risk. Comprehensive baseline surveys shall follow established center protocols. The survey and report shall be completed and submitted to the center IH within 15 business days.

Occupational Exposure Assessments (OEA)01- The Contractor shall provide industrial hygiene consultation to Centers’ IH organizations related to workplace exposure to potentially hazardous chemical, physical, and biological agents. Consultation will include, but is not limited to, the recognition and evaluation of hazardous agents with respect to their impact on employees and organizations, and the provision associated with the supplies being used to ensure items are reordered before they expire.

Equipment that is required under the contract and purchased by the Contractor shall be approved by the COR prior to purchase by the Contractor.

Hazardous Building Materials (HBM)01- The Contractor shall review all aspects of asbestos and lead abatement project processes, including submittals by abatement contractors that delineate controls to ensure the protection of center employees and compliance with Federal and State Regulations, and center requirements.

PWS AREA 5:

Radiation Protection Support (RPS)02- The Contractor shall review all requests for Ionizing or Non- Ionizing Radiation Source or Device Use and User of such for compliance with NRC and/or NASA and Center regulations and coordinate the process of issuing a Use Authorization or Permit for the Use of sources or devices and the issuing of User Approval Documents.

RPS05- The Contractor shall provide services to initiate and maintain safety activities/programs that control the exposure to both ionizing radiation from radioactive elements in equipment (including, but not limited to an x-ray machine or particle accelerator) and non-ionizing radiation (including, but not limited to, a laser, microwave or other equipment found in a wide range of occupational settings). Non-ionizing radiation includes the spectrum of ultraviolet (UV), visible light, infrared (IR), microwave (MW), radio frequency (RF), and extremely low frequency (ELF).

Laser and Laser System (LLS)01- The Contractor shall conduct a laser hazard analysis for each laser being used to determine its classification based on Laser Standards.

LLS03- The Contractor shall develop and maintain requirements specific to the use of lasers that comply with Federal regulations and ANSI standards.

LLS07- The Contractor shall provide oversight and direction to the outdoor laser activities to assure adequate protection of air transportation. The Contractor shall ensure coordination with the NASA Laser Safety Review Board, Federal Aviation Administration, and the US Space Commands Laser Clearinghouse for outdoor laser activities as required by the ANSI standards.