J16 _Past_Performance_Assessment_Questionnaire.doc

N00024-13-R-3041 Attachment 5 N50054-15-R-0004

DEPARTMENT OF THE NAVY

COMANDING OFFICER

MID-ATLANTIC REGIONAL MAINTENANCE CENTER

NNSY, Building 51, PORTSMOUTH, VIRGINIA 23705-0215

Past Performance Assessment Questionnaire

Date:

Contractor/Offeror:

Referenced Contract Number: Task Order Number:

Responding Agency/Company:

The completion of this Past Performance Assessment Questionnaire is requested from the respondent’s (referenced contract) agency/company in order so that Mid-Atlantic Regional Maintenance Center (MARMC) may evaluate the aforementioned contractor’s past performance on previous contracts as it relates to the probability of successful accomplishment of the work required by MARMC relative to the award of the contract resulting from this solicitation.

It is requested that the Responding Agency/Company complete the Past Performance Assessment Questionnaire NO LATER THAN TUESDAY, 03 September 2015 and email the completed form directly to the Procuring Contract Specialist, Wendell D. Davis, by e-mail at wendell.davis@navy.mil. DO NOT return this form to the contractor being evaluated.

NOTE: IT IS THE RESPONSIBILITY OF THE OFFEROR TO ENSURE ALL PAST PERFORMANCE QUESTIONNAIRES ARE SUBMITTED TO THE GOVERNMENT BY THE CLOSING DATE AND TIME IF DATE IS DIFFERENT THAN ABOVE.

If you need more space than that provided, please attach additional pages. Responses will be treated as source selection sensitive information. If you have any questions, please contact the Contract Specialist at the above e-mail address.

Thank you for your quick response and assistance.

1. Contract Information. Please complete the following for the contractor originating this request:

Contractor:

Contract Number:

Task Order Number:

Period of Performance:

Dollar Amount at Award:

Dollar Amount at Completion (or Current Dollar Amount, if not Completed):

Contract Type: Fixed-Price; Labor Hour or Time and Material; Cost-Reimbursement (CPFF, CPAF, CPIF, etc.)

Describe the Products and/or Services that the Contractor/Offeror performed for you under this referenced contract:

The number, type and severity of any quality, delivery or price problems in performing the contract, the corrective action taken and the effectiveness of the corrective action:

2. Performance Assessment Values.

5 - Exceptional. Performance meets contractual requirements and exceeds many requirements, to the Government’s benefit. Contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

4 – Very Good. Performance meets contractual requirements and exceeds some requirements, to the Government’s benefit. Contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

3 – Satisfactory. Performance meets contractual requirements. Contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

2 - Marginal. Performance barely meets some contractual requirements. Contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.

1 - Unsatisfactory. Performance does not meet some or most contractual requirements and recovery is not likely in a timely manner. Contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

0 - Not Applicable. Unable to provide a score. Performance in this area not applicable to effort assessed.

3. Assessment Elements. Please select the appropriate performance assessment value for each item on the questionnaire and provide supporting narrative.

A. Cost Control. Rate the contractor’s effectiveness in forecasting, managing, and controlling cost (including reporting and analyzing variances) and ability to deliver at the agreed-to cost/price. Describe reasons for changes to the contract value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes).

Comments supporting assigned rating:

B. Schedule. Rate the contractor’s ability to deliver according to the agreed-to schedule. What were the causes of any schedule variances?

Comments supporting assigned rating:

C. Quality/Meeting Contract Requirements.

1. Rate the contractor’s ability to provide a product or service that met or exceed the requirements of the contract. Identify contractor’s overall strengths and weaknesses.

Comments supporting assigned rating:

2. How would you describe your level of customer satisfaction?

Comments supporting assigned rating:

3. Were there instances of rework and/or deficiency reports? 5 = Yes, definitely; 4 = Yes, some; 3 = Yes, very rarely; 2 = No, not ever; 1 = N/A.

Comments supporting assigned rating:

4. Rate the contractor’s engagement in effective and/or innovative work applications that were beneficial to the Government?

Comments supporting assigned rating:

5. Rate the contractor’s ability to provide a product or service that met your required level of quality. 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.)

Comments supporting assigned rating:

D. Subcontract Management.

1. Rate the contractor’s ability to meet the goals of the subcontracting plan, to include the ability to timely award and manage subcontracts.

Comments supporting assigned rating:

E. Business Relations.

1. Rate the contractor’s ability to integrate and coordinate all activities needed to execute the contract, specifically the timeliness, completeness, quality of problem resolution and corrective action plans and the effectiveness of corrective actions take.

Comments supporting assigned rating:

2. Rate the contractor’s history of reasonable and cooperative behavior, customer satisfaction, and its ability to submit accurate invoices in a timely manner.

Comments supporting assigned rating:

F. Management of Key Personnel. Assess the contractor’s performance in selecting, retaining, supporting, and replacing—when necessary—key personnel.

Comments supporting assigned rating:

G. Recommendation. To what extent would you recommend this contractor for additional contracts? Rate on the following scale: 5 = Yes, definitely; 4 = Yes, likely; 3 = Maybe, 2 = No, not likely; 1 = No, not ever; 0 = N/A.

Comments supporting assigned rating:

4. Other References. If you are aware of any other contract or a Point of Contact (POC) who is familiar with the contractor’s performance under this contract, please identify.

Name, Phone, and E-Mail Address:

5. Assessor Information. Please provide the following information about yourself:

Name:

Title:

Address:

Phone Number:

E-Mail Address:

Thank you for your assistance.

Please return completed form to wendell.davis@navy.mil prior to Tuesday, 03 September 2015. Do Not Send to Contractor being evaluated.

Source Selection Information – See FAR 2.101 and 3.104

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Source Selection Information – See FAR 2.101 and 3.104