CUI - Attch 6 - Past Performance Questionnaire.docx

49100425R0006 Attachment 6

FROM: U.S. National Science Foundation (NSF) Office of Budget, Finance, and Award Management (BFA), Division of Acquisition and Cooperative Support (DACS)

SUBJECT: Antarctic Science and Engineering Support Contract (ASESC)

Greetings, If you are receiving this letter and attached survey, it is because an entity you (the “client”) have previously done (or are currently doing) business with is interested in responding to a solicitation for the NSF ASESC procurement. Details regarding this procurement can be found through SAM.gov Contract Opportunities under the solicitation number 49100425R0006.

NSF intends to determine the best-value source which can fulfill this requirement. NSF humbly requests your cooperation with the offering entity (“offeror”) for the purposes of providing a complete survey to NSF. Completion of this survey is vital to NSF’s assessment of an offeror’s past performance, without which a full evaluation cannot be carried out.

NSF requests that the client completes this questionnaire and submits it directly back to the offeror. The offeror will submit the complete questionnaire to NSF with their proposal. Clients are highly encouraged to submit questionnaires directly to the offeror. However, questionnaires may be submitted directly to NSF at recompete.usap@nsf.gov.

The Government reserves the right to verify any information on this form.

NSF thanks you for your cooperation.

Miranda Lewis, Contracting Officer National Science Foundation Division of Acquisition and Cooperative Support

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: ☐Prime Contractor ☐Subcontractor ☐ Joint Venture ☐ Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #/Email):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: ☐ Firm Fixed Price ☐ Cost Reimbursement ☐ Other (Please specify): Contract Title:

Contract Performance Location(s):

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy) (if applicable):

Actual Completion Date (mm/dd/yy) (if applicable):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: Title:

Phone Number: Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE OFFEROR’S PERFORMANCE

The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

performing beyond the requirements of the contract.

proposed actions appear only marginally effective or were not fully implemented.

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

magnitude that it alone constitutes an unsatisfactory rating.

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues?

(Includes: following the users’ rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

personnel security requirements.

Please provide responses to the above questions (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

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