J-12_NAV_Past_Performance_Questionnaire.pdf

NOAA AGOR VARIANT (NAV)

Past Performance Questionnaire Form

Attachment J-12

Version 1.0

26 April 2018

Solicitation No. N00024-18-R-2201

DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited.

N00024-18-R-2201

PAST PERFORMANCE QUESTIONNAIRE

Introduction: This Past Performance Questionnaire is a means the U. S. Navy will use to assess

Offerors' and their Subcontractors' past performance on similar vessels or other contracts. The Navy will review the information provided by the Offerors and their Subcontractors, and the information provided by their selected Customers/Past Performance References in the Questionnaire. The Navy may contact these customers/references and use other sources, if deemed necessary, to assess the

Offeror's and/or Subcontractors' past performance.

Instructions to the Offeror: Fill out "Part 1: Contract Description" and send it along with the "Past

Performance Questionnaire" to your Customers/Past Performance References. The

Customers/References will fill out Part 2 and send it to the responsible NAVSEA Procuring

Contracting Officer. See Section L of the solicitation for further instructions regarding this process.

PART 1: CONTRACT DESCRIPTION

Customer/Past Performance Reference (FSCM, CAGE, and DUNN number):

NAME OF CONTRACTOR BEING EVALUATED:

Contract Number:

Date Awarded:

Contract Type (e.g., Firm Fixed Price, Indefinite Delivery/Indefinite Quantity, Cost Reimbursement, etc.):

Brief Description of the Scope of Work, and if applicable, any Challenges for the above contract:

Customer's Buyer, Procurement Agent, Contracting Officer, etc.:

Phone Number:

E-mail Address:

Customer's Technical Representative, Project Engineer, etc., if applicable:

Phone Number:

E-mail Address:

Contract Award Amount Including Options: $

Total Amount of Modifications Excluding Options Exercised: $ Total contract Value At Time of

Contract Completion: $

Contract Completion Date Including Exercised Options:

Required original delivery schedule, actual delivery date, and explanation for any change from the original delivery schedule.

PART 2:

Past Performance Questionnaire

Instructions for Customers/Past Performance References: For each of the following 5 questions, please circle the adjectival term which best describes the Contractor’s performance for the contract identified in Part 1 above. In addition, each question has an optional “Comments” section, in the event that you wish to provide additional narrative information.

1. Overall Contract Performance:

Ability to satisfactorily complete all tasks while conforming to the customer’s requirements, standards of good workmanship, safe practices, compliance with contractual terms and conditions, responsiveness to procuring activity changes, and ability to overcome program difficulties.

Excellent Good Acceptable Marginal Unacceptable

Comments:

2. Technical (Quality of Product):

Ability to successfully perform technical requirements of the contractual effort, accomplish proposed construction processes, methods, and procedures, utilize production facilities and equipment, overcome technical challenges by applying sound business principles, complete required work, responsiveness to technical direction, and ability to integrate as a team with the Government.

Excellent Good Acceptable Marginal Unacceptable

3. Schedule Performance:

Ability to successfully meet the schedule requirements of the subject effort, develop accurate work schedules and adhere to those schedules, ability to overcome schedule difficulties, and any terminations or serious considerations of terminations due to inability to meet schedule predictions.

Excellent Good Acceptable Marginal Unacceptable

4. Management Performance:

Ability to successfully manage the contracted effort, including management of change, organization, manning, workload forecasting, material management (including Government furnished), accommodation of personnel from other Government agencies and authorized private contractors, accurately forecast and control costs throughout all phases of the contract, quality and timeliness of cost reporting and estimating systems, and any terminations or serious considerations of terminations due to inability to meet cost predictions.

Excellent Good Acceptable Marginal Unacceptable

5. Customer Relations:

Degree of customer satisfaction based on the Contractor’s cooperative behavior, general business-like concern for the interest of the customer, customer focused practices, cooperative nature in resolving issues, and ability to solve problems without extensive guidance from procuring/supervising activity counterpart.

Excellent Good Acceptable Marginal Unacceptable

Signature ________________________________ Date _______________

Printed Name ________________________________

And Title ________________________________