Attachment 6 STOCC II Questionnaire.pdf

Source Selection Sensitive Information (When Filled Out)

Attachment 4

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

80KSC025R0008

Attachment 6

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.

HVAC/Mechanical Projects <SAT:

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 and Aaron Kelley at Aaron.L.Kelley@nasa.gov mailto:Benjamin.P.Crafton@nasa.gov mailto:Aaron.L.Kelley@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 Performance meets Performance meets Performance Performance Performance meets contractual contractual contractual does not meet does not meet was not requirements requirements with requirements. The some most observed or not with many some exceeded to contractual contractual contractual applicable to exceeded to the the Government’s performance of the requirements. requirements the current Government’s benefit. The element or sub- The contractual and recovery is effort being benefit. The contractual element contains performance of not likely in a reported contractual performance of the some minor the element or timely manner. against.

performance of element or sub- problems for which sub-element The contractual the element or element being corrective actions being assessed performance of sub-element assessed was taken by the reflects a the element or being assessed accomplished with contractor were serious problem sub-element was no more than some satisfactory. for which the contains a accomplished minor problems for contractor has serious with no more which corrective not yet problem(s) for than a few minor actions taken by identified which the problems for the corrective contractor’s which corrective contractor were actions or the corrective actions taken by effective. contractor’s actions appear the contractor proposed or were were highly actions appear ineffective.

effective. only marginally effective or were not fully implemented.

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: