Attachment J.25 Past Performance Questionnaire.docx

PROCUREMENT SENSITIVE WHEN COMPLETED

FOR OFFICIAL USE ONLY

Battery Type, check the block for which this form is being submitted (only one form may be submitted per type):

24 to 48-Volt Flooded Cell Battery (FCB) (FCB VOR, FCB DCBUS)

120-Volt NiCd Flood Cell Battery (FCB) (FCB Critical Power)

360 to 480-Volt (Large UPS) Flooded Cell Battery (FCB UPS)

360 to 480-Volt (Large UPS) Valve Regulated Lead Acid Battery (VRLA) (VRLA UPS)

24 to 48-Volt Valve Regulated Lead Acid (VRLA) (VRLA VOR, VRLA DCBUS, VRLA Critical Power)

**Large UPS = 40+ modules installed in a cabinet or rack, not mini-UPS. **

Introduction

(Offeror’s name here) is proposing on a Federal Aviation Administration (FAA) replacement of Uninterruptible Power System (UPS) battery strings at FAA facilities. Past performance is of considerable importance to this acquisition.

Please complete this questionnaire on behalf of (Add Offeror’s name here). Indicate, based on the ratings below, the Contractor’s performance on the identified program. Assessments should reflect only performance for which the Contractor is/was responsible. The following is a definition of the rating levels:

Rating Performance Level

4 EXCELLENT: Performance meets contractual requirements and exceeds many requirements to the benefit of the Government/Customer. The contractual performance of the factors being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

3 GOOD: Performance meets contractual requirements and exceeds some requirements to the benefit of the Government/Customer. The contractual performance of the factors being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

2 SATISFACTORY: Performance meets contractual requirements. The contractual performance of the factors contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

1 MARGINAL: Performance does not meet some contractual requirements. The contractual performance of the factors 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.

0 POOR: Performance does not meet most contractual requirements and corrections are not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Please circle (or underline for e-mailed responses) a “Number” or “Yes” / “No” corresponding to your rating or “N/A” if you are unable to provide a rating for an area.

PLEASE PROVIDE NARRATIVE EXPLANATIONS FOR ANY MARGINAL, POOR OR “YES” RATINGS. SPACE FOR YOUR NARRATIVE REMARKS IS PROVIDED ON THE LAST PAGE OF THE QUESTIONNAIRE. IF MORE SPACE IS NEEDED, USE THE BACK OF THE QUESTIONNAIRE.

You are urged to supplement your own knowledge of the Contractor’s performance with judgment of others in your organization. In addition to completing the attached questionnaire for the identified program, we solicit your comments on other similar programs for which your activity has contracts with this offeror.

ATTACHMENT J.25 PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE

PART ONE: INSTRUCTIONS

(Offeror’s name here) is proposing on a Federal Aviation Administration (FAA) replacement of Uninterruptible Power System (UPS) battery strings at US FAA facilities. Past performance is of considerable importance to this acquisition

We would greatly appreciate you taking the time to complete this form. Please provide an honest assessment and return to FAA not later than __________ to:

Federal Aviation Administration Attn: Stefanie Wiles (AAQ-720) E-mail: Stefanie.Wiles@faa.gov

If you have any questions, please contact Ms. Stefanie Wiles.

PART TWO: GENERAL INFORMATION

A. Contractor:

Point Of Contact:

Title:

Telephone No.:

B. Contract Number:

Contract Type:

Period of Performance:

Approximate Dollar Value:

Contract Description:

If performance on the application identified above involved one or more of the following, please mark all that apply:

Replacement of Uninterruptible Power Supply battery strings _____ Replacement of battery back-up system battery string: ______ Re-installation of automatic battery monitoring systems on UPS battery strings _____ Project Management of Battery string replacement _____ Battery supplier _____

PART THREE: QUESTIONS REGARDING SELECTED APPLICATION

The numbers “0” to “4” correspond with the following descriptive values provided on the questionnaire cover page:

PROJECT MANAGEMENT

If provided, how would you rate its usefulness?

Yes or No

0 1 2 3 4 N/A

If site survey was performed how would you rate the site survey report?

Yes or No

0 1 2 3 4 N/A

If yes, how would you rate the contractors work methods and practices on asbestos containing material?

Yes or No

If yes, how would you rate the contractors Arc Flash analysis?

If so, how would you rate the usefulness of work permit in for de-energizing and re-energizing battery strings and equipment, and any Personal Protective Equipment required?

If so, please explain:

Yes or No

a. If so, for what?

b. What corrective action did the contractor take to correct the situation?

Yes or No

If so, why?

Yes or No

INSTALLATION

0 1 2 3 4 N/A

If yes, please rate the battery test plan.

Yes or No

0 1 2 3 4 N/A

If yes, how would you rate the contractors battery baseline testing and data report?

If yes, please rate the reinstallation and battery monitoring system commissioning.

If yes please rate the final clean-up and inspection work.

0 1 2 3 4 N/A

If yes, please rate the UPS charging adjustment.

Would you recommend award of a similar contract to this contractor? Yes or No

Remarks: _______________________________________________________________________

PART FOUR: RESPONDENT INFORMATION

The following information will assist in the analysis of the data provided. Information will be kept CONFIDENTIAL:

Name of Respondent:

Position Title:

Organization:

Telephone No.:

Length of Involvement in Program/Contract:

Date Questionnaire Completed:

THANK YOU!