Attachment__3_Past_Performance_Questionnaire.pdf

Source Selection Information - See FAR 2.101 and 3.104

HQ0034-18-R-0121

Industrial Hygiene and Safety Service Contract Past Performance Questionnaire

PAST PERFORMANCE DATA SHEET

REFERENCE NAME/TITLE: PHONE:

REFERENCE AGENCY:

EMAIL:

Information Request

Washington Headquarters Service/Acquisition Directorate (WHS/AD) is obtaining past performance information with respect to each Offeror. As a reference for work performed by the firm, please complete the questionnaire as thoroughly as possible. The questionnaire must be submitted to primary point of contact: myra.m.freeberg@mail.mil and secondary point of contract:

brittney.j.cowan.civ@mail.mil no later than 11AM Eastern Time on Friday, October 5, 2018.

a.) Quality of Service b.) Timeliness or Scheduling of Service c.) Business Relations/Customer Satisfaction d.) Key Personnel and Staffing (Including Subcontractors)

In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information. This is a major WHS/AD acquisition and your input into this evaluation is greatly appreciated. If you have questions regarding this questionnaire or require assistance, please submit inquiries to myra.m.freeberg@mail.mil or call 703-545-9495. Thank you.

mailto:myra.m.freeberg@mail.mil mailto:brittney.j.cowan.civ@mail.mil mailto:myra.m.freeberg@mail.mil

PAST PERFORMANCE QUESTIONNAIRE

SECTION 1: CONTRACT DATA

Contract Number: Contractor Name:

Contract Title:

Contractor Address:

Contract Value: Contractor DUNS:

Contract Type: Contract Award Date:

Agency/Org. Name: Reporting Period (Start):

Place of Performance: Reporting Period (End):

SECTION 2: DESCRIPTION OF SERVICES

Facility Total Square Footage: _____________

Total Site Acreage: ____________

Service Visit Frequency (Circle all that apply): QUARTERLY MONTHLY BI-WEEKLY WEEKLY DAILY OTHER _________

Please give any additional information concerning the industrial hygiene and safety services provided by this Contractor at this facility.

CONTRACT PERFORMANCE PERFORMANCE EVALUATION SURVEY RATINGS

The following ratings and definitions apply to the Quality of Product or Service, Schedule, Cost Control, Business Relations, and Management of Key Personnel factors:

Rating Definition Note Exceptional Performance meets contractual requirements and exceeds many to the Government’s benefit. 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.

To justify an Exceptional rating, identify multiple significant events and state how they were of benefit to the Government. 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.

Very Good Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

To justify a Very Good rating, identify a significant event and state how it was a benefit to the Government. There should have been no significant weaknesses identified.

Satisfactory 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 appear or were satisfactory.

To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract. There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

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

To justify Marginal performance, identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the Government. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter).

Unsatisfactory Performance 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.

To justify an Unsatisfactory rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the Government. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g., management, quality, safety, or environmental deficiency reports, or letters).

N/A N/A (not applicable) should be used if the rating category does not apply

Please explain all ratings of N/A

SECTION 3: EVALUATION FACTORS

Please provide ratings and comments regarding the Contractor’s performance in each area below using the ratings mentioned above.

Overall Past Performance Rating: Please provide an overall rating of the contractor’s past performance for the reference contract/delivery order.

RATING Provide comments on overall past performance rating:

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

N/A

1. Quality of Product or Service. Assess the Contractor's conformance to contract requirements, specifications and standards of good workmanship (e.g., commonly accepted technical, professional, environmental, or safety and health standards).

RATING Provide comments on Quality of Product or Service:

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

N/A

2. Timeless or Schedule of Services/Deliveries. Assess the timeliness of the Contractor against the completion of the contract, task orders, milestones, delivery schedules, and administrative requirements (e.g. efforts that contribute to or effect the schedule variance).

This assessment of the Contractor's adherence to the required delivery schedule should include the Contractor's efforts during the assessment period that contributes to or effect the schedule variance. This element applies to contract closeout activities as well as contract performance. Instances of adverse actions such as the assessment of liquidated damages, or issuance of Cure Notices, Show Cause Notices, and Delinquency Notices are indicators of problems which may have resulted in variance to the contract schedule and should therefore be noted in the evaluation.

RATING Provide comments on Schedule:

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

N/A

3. Business Relations/Customer Satisfaction. Assess the integration and coordination of all activity needed to execute the contract, specifically the timeliness, completeness and quality of problem identification, corrective action plans, proposal submittals, the contractor's history of reasonable and cooperative behavior (to include timely identification of issues in controversy), customer satisfaction, timely award and management of subcontracts.

RATING Provide comments on Business Relations:

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

N/A

4. Management of Key Personnel and Staff (Including Subcontractors) Assess the Contractor's performance in selecting, retaining, supporting, and replacing, when necessary, key personnel.

RATING Provide comments on Management of Key Personnel:

Exceptional

Very Good

Satisfactory

Marginal

Unsatisfactory

N/A

5. Customer Satisfaction

Was the contractor committed to customer satisfaction? Yes No

Would you recommend the selection of this firm again? Yes No

Provide comments on Customer Satisfaction:

END