N0002423R4204 Attachment J(S)-2 Past Performance Questionnaire.pdf

N00024-23-R-6204

PAST PERFORMANCE QUESTIONNAIRE

Offerors are responsible for sending copies of the PAST PERFORMANCE

QUESTIONNAIRE (next four pages) to reference.

Instructions to Offeror

1. For each reference submitted in your proposal, enter the required information in Section A.

2. Transmit the entire questionnaire to the identified Points of Contact (POCs) and place one copy of each Section A in your proposal submittal.

NOTES:

OFFERORS MUST TRANSMIT THE QUESTIONNAIRES TO THE POC FOR EACH

REFERENCE. ONCE COMPLETED BY THE POC, QUESTIONNAIRES MUST BE

DIRECTLY TRANSMITTED TO THE GOVERNMENT AS DESCRIBED ON THE

FOLLOWING PAGE. COMPLETED QUESTIONNAIRES RECEIVED FROM OFFERORS

ARE NOT ACCEPTABLE.

PAST PERFORMANCE QUESTIONNAIRE

Instructions to Evaluator

The Naval Sea Systems Command is procuring services for the dismantlement and recycling of ex-

CHAMPION (MCM 4), ex-SCOUT (MCM 8), and ex-ARDENT (MCM 12). Evaluation of an

Offeror’s past performance is integral to our source selection process. Accordingly, we request your candid assessment of the Offeror’s past performance; please see Section A below for the identity of the Offeror and contract of interest.

Once completed, this questionnaire and any appended information becomes Source Selection

Sensitive, and must be protected from disclosure. Access to this information shall be limited to

Government procurement officials.

Please forward the completed questionnaire no later than 15 May 2023 to:

Naval Sea Systems Command, Code 0241A

Bldg 197, Rm. 5W-1611

1333 Isaac Hull Ave., SE

Washington Navy Yard, DC 20376

Attn: Ms. Kelli Wright

Email: victoria.m.hill20.civ@us.navy.mil

Tel. Nos.: Facsimile: (202) 834-8351

Voice: (202) 781-1455

Hand-written evaluations are acceptable. All evaluations must relate solely to the Offeror and the contract, task, or order identified in SECTION A. Please answer each question in SECTION B by circling one of the ratings O E G M U N/A, where:

O-Outstanding; E-Excellent; G-Good;

M-Marginal; U-Unsatisfactory; N/A-Not Applicable

Outstanding - Contractor performance substantially exceeded expected levels of performance.

Excellent - Contractor performance exceeded expected levels.

Good – Performance met expected levels.

Marginal - Performance was less than expected.

Unsatisfactory - Performance was significantly less than expected.

In addition, please provide supporting comments for each rating. Please use your supporting comments to highlight the Offeror’s specific strengths and weaknesses. You may use additional sheets if required. Your ratings and comments should reflect only “contractor liable” performance. You may supplement your knowledge with the knowledge and judgment of others in your organization.

Please enter the requested information in SECTION C for the person primarily responsible for completing the questionnaire, then transmit the completed questionnaire to the point of contact identified above. Thank you for your assistance in this matter.

PLEASE DO NOT PROVIDE COMPLETED QUESTIONNAIRES TO THE OFFEROR

SECTION A (To Be Completed by the Offeror)

1. Name of Offeror/Contractor: __________________________________________________

Address of Offeror/Contractor: ________________________________________________

2. Contract Number: __________________________________________________________

Task or Order No., where applicable: ___________________________________________

3. Period and Place of Performance: ______________________________________________

4. Description of Work/Scope of Effort (max. 50 words): _____________________________

5. POC Name: ___________________________________________________________

Address: _____________________________________________________

Tel. No.:

Voice: ___________________________ Facsimile: ____________________

6. Method and Date Questionnaire Sent to POC:

Date: _________________________ Method: _______________________________

SECTION B (To Be Completed by Evaluator)

O-Outstanding; E-Excellent; G-Good;

M-Marginal; U-Unsatisfactory; N/A-Not Applicable

1. Overall Contract Outcome: O E G M U N/A Ability to satisfactorily complete all tasks while conforming to customer requirements, standards of good workmanship and safe practices.

Comments: ___________________________________________________

2. Cost Performance: O E G M U N/A

Ability to accurately forecast and control costs throughout all phases of the contract.

Comments: ___________________________________________________

3. Schedule Performance: O E G M U N/A Ability to develop accurate work schedules and adhere to those schedules as well as the ability to adapt to changes in requirements and work schedules.

Comments: ___________________________________________________

4. Technical Performance: O E G M U N/A Ability to overcome technical challenges by applying sound engineering principles, complete required engineering analyses, and develop adequate technical reports and plans.

Comments: ___________________________________________________

5. Customer Relations: O E G M U N/A Degree of customer satisfaction based on the contractor's cooperative behavior, general business-like concern for the interest of the customer, and customer orientated management practices.

Comments: ___________________________________________________

6. Small, Small Disadvantaged, and Women-owned Business: O E G M U N/A Compliance with subcontracting plan goals for Small, Small Disadvantaged, and Women-owned business concerns and monetary targets for such concerns.

Comments: ___________________________________________________

SECTION C (To Be Completed by Evaluator)

1. Name of Evaluator: _____________________________________________________________

2. Position Title and Grade: _________________________________________________________

3. Administrating Authority/Agency: _________________________________________________

4. Tel. Nos: Voice ___________________________ Facsimile __________________________

5. Signature: _________________________________ Date: ___________________________

Please transmit completed questionnaire by US Mail to Victoria Hill, Naval Sea Systems Command, Code 0242, Bldg. 197, Room 5W-2645, 1333 Isaac Hull Avenue, SE, Washington Navy Yard, DC

20376 or by fax to (202)781-4637.