J.1(b)3 Past Performance Questionnaire.pdf

J.1.(b), Att. 3 80ARC024R0009

This form will contain source selection information upon completion

CLIENT AUTHORIZATION LETTER

, 2024

Dear Client:

We are currently responding to a Request for Proposal (RFP) for the NASA Ames Research Center (ARC) Center Occupational Safety, Health, Medical, System Safety, and Mission Assurance Contract (COSMC) procurement. The purpose of the COSMC procurement is to acquire safety, health, medical and mission assurance services and related services for the ARC Safety and Mission Assurance Directorate. Performance of these services will primarily be at NASA ARC. Armstrong Flight Research Center (AFRC) may also order System Safety and Mission Assurance services from the contract.

Past performance is a factor for source selection under this solicitation. As such, a requirement of NASA’s solicitation is that past clients of ours are asked to provide an impartial assessment of our performance and the scope of work performed on the contract reference performed for your organization.

We have identified of your organization as the point of contact based on his/her knowledge concerning our work.

Please complete the enclosed Past Performance Questionnaire and forward it directly to NASA Contracting Officer, Marla P. LeFevre at the following email address, marla.p.lefevre@nasa.gov.

A response to this questionnaire is requested to the above email address no later than . (Offeror to complete)

Thank you for completing this questionnaire. Any questions may be directed to the undersigned.

Sincerely, Enclosure

Summary of the scope of work under the COSMC procurement

The COSMC Performance Work Statement (PWS) supports NASA Ames Research Center Safety and Mission Assurance Directorate activities that in turn support ARC organizations, facilities, and projects.

Contract requirements include:

(1) Contract Management - ensures that the proper resources are available and allocated to assigned tasks; appropriate work is being done to accomplish those functions and tasks on agreed schedules;

contractor staff meets the education, training and/or certifications appropriate for their tasks, required data is generated; required reports and documentation are prepared; compliance with safety and health requirements; environmental compliance; and Contractor employee performance supports the Government’s objectives.

(2) Health Physics – Provide oversight of all research operations using ionizing radiation sources

(radioisotopes regulated by the Nuclear Regulatory Commission and other radiation-generating equipment) and non-ionizing radiation (lasers, ultraviolet light, microwave and radiofrequency transmitters) at ARC.

(3) Medical Services - Includes three primary services: Emergency medical response, occupational health, and health maintenance services at ARC.

(4) Fitness Center – Staff and operate the Ames Fitness Center (FC), which provides a safe and clean environment for ARC staff to exercise on site. The facility contains aerobic equipment, weights, a classroom, and locker rooms/restrooms. Qualified staff maintain the facility and conduct a variety of fitness classes.

(5) Industrial Hygiene – includes recognition, evaluation, management and control of chemical, biological, physical, and ergonomic hazards. Industrial hygiene programs include Asbestos and Lead Program, Biosafety Program, Chemical Exposure Assessment and Control Program, Cryogen and Toxic Gas Hazardous Atmosphere Monitoring Program, Food Safety Program, Nanomaterials Program, Noise Monitoring and Hearing Conservation Program, Respiratory Protection Program, Ventilation Program, and Indoor Air Quality Program.

(6) Occupational Safety - Includes implementation of the following programs: Construction Safety, Hazardous Energy Control Program, Explosives and Propellants Safety Program, Fall Protection Program, Safety Culture Recognition and Communication Program, Voluntary Protection Program, Confined Space Entry Program, and Fire Protection Engineering.

(7) System Safety and Mission Assurance – Includes support in the areas of flight projects, risk management, system safety, quality assurance, software assurance and software safety, pressure system safety, reliability and maintainability engineering, and operational safety.

PAST PERFORMANCE QUESTIONAIRE

Contract Information

Contractor Name:

Contract Name:

Contract Number:

Agency/Company / Organization Name:

Point of Contact Name and Title/Position:

Point of Contact Email:

Point of Contact Phone:

General Contract Information

Please provide the following information about this contract and the contractor’s role:

1. Provide a brief description of services provided by the contractor under this contract. Of the seven requirements areas listed in the summary on page 2, please specifically list the requirement areas (i.e., areas 1-7) which were/are performed under your contract. Additional detail describing specific areas of performance within each of the 7 areas is encouraged.

2. Type of Contract

Firm Fixed Price ☐ Cost Plus Fixed Fee ☐ Cost Plus Award Fee ☐ Other (Describe): ☐

3. Method of Competition

Non-Competitive ☐

Competitive (provide description—e.g., Full and Open, Small Business Set-Aside, etc.)

Follow-on ☐ New requirement ☐

4. Period of Performance (including options/ extensions):

From: To:

5. Was the contractor the Prime or Sub?

6. If the contract involved task orders, then provide the average number of task orders per year:

7. Total Contract Value (including all options): $

8. Briefly describe any change(s) from original contract value (including cost overruns):

9. Was there a cost overrun? ( ) Yes ( ) No

If yes, please explain (please address any overruns in direct and indirect costs, such as increases in overhead rates, and their impact on overall cost performance):

Please use the following adjectival ratings to respond to the questions on the following pages.

Please select one rating per statement, using the following definitions and provide supporting information to further explain any rating, as well as in response to the more detailed questions.

Definition of Ratings

Excellent

(E)

Performance was/is of exceptional merit. It indicates exemplary performance in a timely, efficient, and economical manner and very minor (if any) problems with no adverse effect on overall performance.

Very Good

(VG)

Performance was/is very effective. The performance was/is timely, efficient and economical with only minor problems having no adverse effect on overall performance.

Good (G) Performance was/is effective. The performance was fully responsive to contract requirements with reportable problems, but with little identifiable effect on overall performance.

Fair (F)

Performance met/meets or slightly exceeds minimum acceptable standards. Adequate results were achieved and there are/were reportable problems with identifiable, but not substantial effects on overall performance.

Poor (P)

Performance did not/does not meet minimum acceptable standards in one or more areas. Remedial action is/was required in one or more areas. Performance problems occurred in one or more areas which adversely affected overall performance.

Not Applicable (N/A) The contractor did not perform this task/scope of work.

Attachment J.1.(b).6. 80ARC023R0006

CONTRACTOR’S PERFORMANCE

Please evaluate the contractor’s performance under this contract for the specific services, scope or functions listed below. Please ensure that the rating is consistent with the Definition of Ratings provided above. Please provide supporting information to further explain the selected rating.

PERFORMANCE RATING

(Please circle)

1. Evaluate the contractor’s management of multiple, concurrent, and complex tasks, including management and negotiation of task orders and the quality of task order proposals.

E

VG

G

F

P

N/A

Supporting information for the rating:

2. Evaluate the contractor’s record in recruitment, training and retention of employees with the appropriate skills and expertise for contract and task order performance.

3. Evaluate the effectiveness of the contractor's quality assurance process, including their performance monitoring techniques, tracking and reporting quality metrics to the customer, and management and resolution of contract performance problems.

4. Evaluate the contractor’s technical performance in the area of Health Physics E VG G F P N/A

5. Evaluate the contractor’s technical performance in the area of Medical Services. E VG G F P N/A

6. Evaluate the contractor’s technical performance in the area of Fitness Center operation. E VG G F P N/A

7. Evaluate the contractor’s technical performance in the area of Industrial Hygiene. E VG G F P N/A

8. Evaluate the contractor’s technical performance in the area of Occupational Safety. E VG G F P N/A

9. Evaluate the contractor’s technical performance in the areas of System Safety and Mission Assurance. E VG G F P N/A

10. Describe any serious contract performance problems (e.g., termination for default, regulatory violations) resulting from contractor’s performance.

Submitted By (Signature) Date