A04_Past_Performance_Questionnaire_Part_I-II.pdf

PAST PERFORMANCE QUESTIONNAIRE

Your organization has been identified for participation in past performance evaluation on a current solicitation at the National Institutes of Health (NIH) at Bethesda, Maryland.

This information contained in this questionnaire will be used to evaluate the past performance for the contractor and contracting action identified below.

Request for Proposal NIHOF2015030

Electrical Vault 11 Transformer and Switchgear Replacement, ACRF, Bethesda Construction Services Contract

Your candid response to the questions is important to our evaluation effort and may affect the award outcome. Please indicate "Unknown" in any area that was not applicable to work performed on your contracting action.

THE COMPLETED FORM MUST BE SUBMITTED BY MAIL, FAX OR E-MAIL TO

THE FOLLOWING ADDRESS:

Regular mail:

ATTN: Kimberly Goodwin Contracting Officer National Institutes of Health Building 13, Room 2E48 9000 Rockville Pike, Bethesda, Maryland 20892-5738

FAX:

301-402-1103

E-mail:

Kimberly.Goodwin@nih.gov

If you have any questions/ concerns pertaining to this survey and/or the requested information please contact Kimberly Goodwin, Contracting Officer, AECCB, National Institutes of Health, Office of Research Facilities, at 301-451-7243.

Thank you for your time and effort in completing this survey.

PAST PERFORMANCE QUESTIONNAIRE for NIHIOF2015030

PART I – TO BE COMPLETED BY CONTRACTOR

Item Requested Information Information Provided by Contractor

A. Contractor Name

Contractor Address

B. Contract / Task Order Number

Role on Contract: [ ] Prime [ ] Subcontractor

If Subcontractor, Prime Contractor Name

C. Contract Type [ ] Competitive [ ] Sole Source

[ ] IDIQ Task Order [ ] Single Award [ ] Other

[ ] Fixed Price or Fixed Unit Price [ ] T&M or Cost Reimbursement

D. Initial Performance Dates From: To:

Extensions From: To:

E. Initial Costs $

Extensions Costs $

Total Costs $

F. Work Complexity [ ] Difficult [ ] Routine

G. Was Contract Canceled Prior to Scheduled Completion

Date?

[ ] Yes [ ] No

H. Brief Description of Work

I. Reference Organization / Agency Name

J. Reference Organization Work Functions

K. Reference Giver - Name, PAST PERFORMANCE QUESTIONNAIRE for NIHIOF2015030

PART I – TO BE COMPLETED BY CONTRACTOR

Item Requested Information Information Provided by Contractor

Title

Telephone

Email:

Extent of contact with Offeror personnel (daily, weekly, etc.)

PAST PERFORMANCE QUESTIONNAIRE for NIHOF2015030

PART II – TO BE COMPLETED BY OFFEROR’S REFERENCE

DEFINITIONS

Please use the following definitions when completing the Past Performance Questionnaire:

Rating Description

Essentially no doubt exists that the offeror successfully performed the required effort based on their performance record.

Little doubt exists that the offeror successfully performed the required effort based on their performance record.

Some doubt exists that the offeror successfully performed the required effort based on their performance record.

Significant doubt exists that the offeror successfully performed the required effort based on their performance record.

It is extremely doubtful that the offeror successfully performed the required effort based on their performance record.

N/A The offeror has little/no relevant past performance upon which to base a meaningful performance prediction. This indicates neither a favorable nor unfavorable rating.

INSTRUCTIONS

On a scale of 1 to 5 (5 being the highest rating) rate the Offeror’s performance for each of the items listed below. Place a ‘rating’ in the appropriate column using the definitions above.

Item On a scale of 1 to 5 (5 being the highest rating) How do you rate the Offeror’s...?

Rating

Comments Please explain the rationale for each score in sufficient detail to facilitate the Technical Evaluators in their review of the survey results. Please indicate if an item is not applicable to the representative project.

1 - Offeror’s Quality Control Did the Contractor demonstrate an interest in the quality of workmanship of his personnel?

Did the contractor provide an adequate quality control plan and implement the plan with success?

Provided effective quality control and/or inspection procedures to meet contract requirements.

Was the documentation required by the quality control plan submitted timely and correctly?

When deficiencies were found, were they identified and corrected in a timely manner?

How would you rate the quality control of construction?

Quality Control Average Score

2 – Offeror’s Timeliness Performance

What was the level of accuracy in forecasting and controlling schedules?

Were there any delays and if so was resolution taken care of in a timely

Were warranty calls, if placed, answered in a timely manner?

Did the contractor pay subcontractors/suppliers in a timely

Provided services or completed task orders in accordance with the delivery schedule?

Timeliness Average Score

3 - Effectiveness of Offeror’s Management:

Provided experienced managers and supervisors with the technical and administrative abilities needed to meet contract requirements.

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel during the contract period.

Firm’s principals participated in solving significant local problems.

How effective was the level of communications?

Was the contractor cooperative and responsive to all concerns?

How would you rate the level of professionalism and integrity with which they conducted business?

Was there coordination and control of the contractor’s sub-contractor base and if problems arose was there timely resolution?

Was the Sub-contracting Plan implemented?

Was there adequate site clean up?

Was there effectiveness in forecasting and controlling costs?

Provided accurate and complete line item cost proposals and schedule impacts for all aspects of work required for each change order?

How would rate the level of cooperation during the building Commissioning process?

How would rate the level of coordination provided during the occupancy/activation process?

Effectiveness of Management Average Score

4 – Compliance with Labor and Safety Standards:

Were payrolls properly completed and submitted?

Was the contractor’s safety plan adequate and was it implemented satisfactorily on a daily basis?

If deficiencies were found in either labor or safety standards, were they corrected timely?

Labor and Safety Standards Average Score

5 – General Questions How would you rate the contractor’s overall performance?

Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “Comments.”

YES________ NO_________

Would you award another contract to this contractor? If not, explain in “Comments.”?

YES________ NO_________

General Average Score

Customer’s Overall Average Rating (Average of All Categories)

If you have any comments concerning the referenced contractor which you feel would be of benefit to our evaluation for past performance, or want to explain further any answer to the above questions please provide them on this page.