Attachment 5_Past Performance Questionnaire.pdf

Source Selection Sensitive Information (When Filled Out)

Source Selection Sensitive Information (When Filled Out)

ATTACHMENT 5 - PAST AND PRESENT PERFORMANCE

QUESTIONNAIRE

80KSC026R0007 – Launch Complex (LC) 39 Area Duct Bank System Replacement

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 5 years, please complete separate evaluation forms for those contracts as well. IF THE REFERENCED PROJECT/CONTRACT HAS BEEN RATED IN A Contractor Performance Assessment Reporting System (i.e. CPARS) a copy or reference to that report will suffice in lieu of completing this questionnaire.

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 and Jacqueline Brooks at jacqueline.a.brooks@nasa.gov mailto:benjamin.p.crafton@nasa.gov mailto:jacqueline.a.brooks@nasa.gov

D. PERFORMANCE INFORMATION: Please rate the Offeror utilizing the guide below. Explanatory narratives for as many responses as possible would be appreciated. These narratives need not be lengthy, just detailed. Attach additional pages if more space is needed.

Evaluation Definitions – The following definitions should be used in the assessment of Offeror’s performance.

Past Performance Evaluation Question 1. Performance

What is your assessment of the DBC’s ability to meet work requirements?

Exceptional Very Good Satisfactory Marginal Unsatisfactory

Performance

Comments, if any:

EXCEPTIONAL

Performance EXCEEDED MOST contractual requirements. The work performance was accomplished with few minor issues or concerns.

VERY GOOD

Performance EXCEEDED SOME contractual requirements. The work performance was accomplished with few minor issues or concerns, for which the Design-Build Company's (DBC) corrective actions were highly effective.

SATISFACTORY

Performance MET contractual requirements. The performance of the areas being assessed contains minor issues or concerns, for which corrective actions taken by the DBC were effective.

MARGINAL

Performance MET SOME contractual requirements. The work performance included significant problems, issues, or concerns for which corrective actions taken by the DBC were only somewhat effective.

UNSATISFACTORY

Performance DID NOT MEET contractual requirements. The work performance included serious problems, issues, or concerns for which the DBC’s corrective actions were ineffective.

Question 2. Conformance to Contract Requirements What is your assessment of the DBC’s ability to conform to the contract requirements?

Exceptional Very Good Satisfactory Marginal Unsatisfactory

Conform to Contract

Requirements

Comments, if any:

Question 3. Timeliness and Contract Schedule Adherence What is your assessment of the DBC’s ability to complete work tasks in a timely manner?

Exceptional Very Good Satisfactory Marginal Unsatisfactory

Timeliness

Ability to Resolve Timeliness Problems

Adherence to Contract Schedules

Comments, if any:

Question 4. Business and Management What is your assessment of the DBC’s ability to conduct business in a timely and professional manner?

Exceptional Very Good Satisfactory Marginal Unsatisfactory

Management Responsiveness

Reasonable and Cooperative Behavior/

Commitment to Customer

Satisfaction

Concern for the Customer

Comments, if any.

Question 5. Quality of Work What is your assessment of the DBC’s ability to provide quality work and the overall quality of the project?

Quality of Work

Adherence to Good Workmanship

Comments, if any.

Question 6. Overall Rating of Contractor’s performance What is your overall rating of the DBC’s performance (requirements, schedule, and price) on contract being assessed?

Question 7. Would you work with this firm again?

Yes No

General Comments: