Attachment (13) - PPQ Form.docx

The Naval Surface Warfare Center Philadelphia Division (NSWCPD) Bldg 77H Repair Pump Motor 1C Attachment 13 Past Performance Questionnaire

The Contractor shall complete the company specific information on this form for past performance project examples that the Contractor will be providing, contact their clients, forward this form to their clients and request that their clients complete it and send it via email to the listed individual before the closing time for receipt of offers: Rishi Mathur; rishi.m.mathur.civ@us.navy.mil and David Rhoads; david.a.rhoads8.civ@us.navy.mil. This will expedite the response from each referenced source.

Please title the subject line of the e-mail to read “SOLICITATION NO. N6449825R4010 – Past Performance Questionnaire”

*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 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 Contracting Officer at the above e-mail addresses.

1. Contract Information (Note: The CONTRACTOR SHALL ONLY COMPLETE SECTION)

a) Contractor Name: ______________________________________________________________

b) Contract Number: ______________________________________________________________

c) Performed as Prime or Subcontractor (Circle or Highlight): PRIME SUBCONTRACTOR

d) Describe your role as Prime or Subcontractor under this effort: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

e) Total period of performance (Start/Completion date; month and year):

f) Total Contract Dollar Amount at Completion (or Current Contract Dollar Amount, if not Completed:______________________________________________________________

g) Describe Project Location (town, city, state, building name, or building number, etc.): __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

i) Contract Type (FFP, Labor Hour, Time & Materials; Cost Reimbursement (CPFF, CPIF, CPAF, etc.): ___________________________________________________________________

CONTRACT ASSESSMENT

2. Contract Relevancy. For comparison with the size and scope of this acquisition, please provide the following information pertaining to the contract identified in Section 1 above.

______ Project Management ______ Industrial/Commercial cooling tower pump and motor ______ Quality Control ______ Acquisition and Contract Management Support ______ Technical Expertise ______ Other Support (please describe: _____________________)

3. Performance Assessment Values (Please Circle or Highlight Rating # 1-5 for examples below)

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

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

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

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

3 - 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.

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

2. – Marginal. Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated 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.

Note: To justify Marginal performance, identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the Client. 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).

1 - 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.

Note: To justify an Unsatisfactory rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the Client. 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).

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

4. Assessment Elements. Please select/circle 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. Provide reasons for changes to the contract value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes).

5 4 3 2 1 0

Comments:

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

5 4 3 2 1 0

Comments:

c. Mission Requirements Rate the contractor’s ability to provide a product or service that met your mission requirements.

5 4 3 2 1 0

Comments:

d. Quality 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.). Assess the contractor’s ability to test system performance characteristics and provide technical reports on the results.

5 4 3 2 1 0

Comments:

e. Business Relations Rate the contractor’s ability to integrate and coordinate all activities needed to execute the contract, specifically the timeliness, completeness, quality of problem resolution, corrective action plans, the contractor’s history of reasonable and cooperative behavior, customer satisfaction, and its ability to submit accurate invoices in a timely manner.

5 4 3 2 1 0

Comments:

f. Safety Environment To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

5 4 3 2 1 0

Comments:

g. Coordination Rate the contractor’s ability to coordinate system outages with your facility’s needs and minimize the time the system is out-of-service.

5 4 3 2 1 0

Comments:

h. Proactive to Potential Risks Rate the Contractor’s ability to proactively identify risk areas, mitigate risks, and respond to emergency and critical situations?

5 4 3 2 1 0

Comments:

i. Security Rate the Contractor’s compliance with all security requirements for the project and personnel security requirements.

5 4 3 2 1 0

Comments:

j. Job Site Rate the Contractor’s ability to perform work such that the work-site remained in a clean and organized manner throughout the execution of work?

5 4 3 2 1 0

Comments:

k. 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.

5 4 3 2 1 0

Comments:

5. 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:

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

Name:

Title:

Address:

Phone Number:

E-Mail Address:

Thank you for your assistance.