Attachment 4 STOCC Questionnaire.pdf

Source Selection Sensitive Information (When Filled Out)

Attachment 4

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

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A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ____________________ Telephone Number: ____________________ Address: __________________________ Fax Number: _________________________ __________________________ Point of Contact: ______________________

(The government enters the following information based on list of references provided by the offeror. The offeror will enter this information if the solicitation requires him to submit questionnaires to the references.)

Project Title and Brief Description of Work: _____________________________________*

Contract Number Provided by Offeror: ___________________ Dollar Amount: ________*

Contract Period or Dates of Performance Provided by Offeror: ______________________* Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ______________________________

Address: _____________________ Telephone Number: _________________

_____________________________ Fax Number: _____________________

_____________________________ Email Address: _____________________

C. EMAIL COMPLETED SURVEY FORM TO: Ben Crafton at benjamin.p.crafton@nasa.gov.

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

E G S M U N

Exceptional Very Good Satisfactory Marginal Unsatisfactory Neutral

Performance meets contractual requirements with many exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements with some exceeded to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

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 were satisfactory.

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 or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

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.

was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

The contractor… E G S M U N

1. Was timely in fulfilling contract requirements (submitting documents, material submittals, shot drawings, etc)?

2. Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

3. Demonstrates ability to hire, manage, & replace if necessary, qualified personnel/subcontractors in order to meet contract requirements.

4. Demonstrates ability to keep change orders to a minimum with reasonable pricing.

5. Provided effective quality control and/or inspection procedures to meet contract requirements.

6. Use of Specified Materials – contractor used specified or equal material or products.

7. Suggested alternative approaches and displayed initiative to solve problems.

8. Accuracy of proposals submitted (SOW, estimates, and drawings), and response time of submitting proposals for change orders

9. Company HQ participated in solving significant local problems

10. Provided timely resolution of warranty defects.

11. Developed realistic progress schedules and stayed on schedule

12. Adequacy of site cleanup- all work and storage areas are cleaned and secured at end of each day

13. Quality of work performed.

14. How would you rate the contractor's overall performance?

15. Please rate the Contractor’s performance as it relates to Safety issues such as the use of protective equipment, fall protection and incidents that resulted in injury.

16. Please rate the Contractor’s performance as it relates to Environmental issues such as waste management and wildlife concerns

17. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in remarks.

YES/NO

18 Was design work involved in this project? If YES, was it adequate? Please make comments in remarks if NO.

YES/NO

FOLLOWING QUESTIONS BASED ON CONTRACTOR’S EFFORTS ACROSS MULTIPLE CONTRACTS:

19. Did the effort involve managing at least five (5) projects simultaneously with a combined value over $750K ?

YES/NO/NA

20. Did the effort involve managing at least two (2) projects simultaneously with a combined value over $1.5M?

YES/NO/NA

21. Did the effort involve managing at least two (2) projects simultaneously with a combined value over $100K ?

YES/NO/NA

22. Circle the disciplines involved with this project: Carpentry, Electrical, Plumbing, HVAC, Masonry, Fire Protection, Roofing, and Painting.

23. Did the contractor run into major problems? If yes, how many times and how effective was their corrective actions? Please write in below or in remarks.

24. What is the contractor’s greatest strength? Please write in below or in remarks.

25. Any weaknesses or areas of concern? Please write in below or in remarks.

26 Was this a Design-Build project? Did the Prime contractor manage the Design- Build process satisfactorily between: the Client, the Design A/E firm, and the construction team members? Were issues resolved in a satisfactorily manner?

Please write in below or in remarks.

27 Please rate the Contractor's Performance as it relates to resolving Safety Issues, implementation of Corrective Actions to address Safety violations.

Sustainment/Application of Corrective Actions through subsequent task order work.

CONTRACTOR’S NAME: __________________________CONTRACT NUMBER _______________________

Remarks:_____________________________________________________________________________________