Attachment_J-7_Past_Performance_Questionnaire.pdf

NNA16543413R 06/07/2016

PAST PERFORMANCE QUESTIONNAIRE

AMES BIOSCIENCES COLLABORATIVE FACILITY N288

NASA AMES RESEARCH CENTER, MOFFETT FIELD, CALIFORNIA

The Contractor listed in this form is being considered in a source selection by NASA Ames Research Center. Please provide information and comments regarding the Contractor’s past performance. Your comments are considered Source

Selection Sensitive, therefore, your name as a reference will not be released. In order to maintain the integrity of the source selection process, we respectfully request that you do not divulge the name of the Contractor nor discuss your comments on this questionnaire with any other individuals.

PLEASE RETURN THIS FORM BY MAIL OR E-MAIL TO:

NASA Ames Research Center

Attn: Robin Wong, Mailstop 241-1

Moffett Field, CA 94035-0001 Email: robin.l.wong@nasa.gov

I. Contract Information

A. Name of Company/Division Being Evaluated:____________________________________________________

B. Contract Number:__________________________________________________________________________

C. Project Title and Location:___________________________________________________________________

D. LEED Certification Level: Attempted: Certified______ Silver______ Gold______ Platinum______

LEED Certification Level: Achieved: Certified______ Silver______ Gold______ Platinum______

E. Contract Start Date, Month/Year ____________ Originally Planned Completion Date, Month/Year ________

Actual Completion Date: ____________ if different from original completion, explain difference: ____________

F. Contract Value at Award:_______________ Value of Modifications:_______________

Total Contract Value: ______________

G. Type of contract/order: Firm Fixed Price _____Cost Plus Award Fee_____Other (specify): __________

Delivery method: Design-Build: _______ Design-Bid-Build: _______

II. Description of Contract

Briefly describe the scope of the contract: __________________________________________________________ mailto:robin.l.wong@nasa.gov

This firm was the:

Prime Contractor _____ Subcontractor ______ Team Member______ Other (describe) ____________

Joint-Venture ___________ Team _________ Individual entity___________

Describe how the contract was managed, including roles and responsibilities of each entity of the joint–venture or team: _____________________________________________________________________________________

Does a corporate or business relationship exist between the firm being evaluated and your organization?

Yes______ No _______If yes, please describe: ___________________________________________

III. General Performance Survey

Use the following ratings to respond to the questions below. Please select one rating per statement, using the following definitions. Please provide additional remarks to further explain any rating and in response to the more detailed questions.

Definition of Ratings

Excellent (E) The Offeror’s performance was demonstrated with exceptional merit indicating exemplary performance to contract requirements with contract requirements accomplished in a timely, efficient, and economical manner; very minor (if any) problems with no adverse effect on overall performance.

Very Good (VG) The Offeror’s performance was demonstrated very effectively and was fully responsive to contract requirements with contract requirements accomplished in a timely, efficient, and economical manner for the most part with only minor problems with little identifiable effect on overall performance.

Good (G) The Offeror’s performance demonstrated successful performance by the offeror and was fully responsive to contract requirements with contract requirements accomplished in a timely, efficient, and economical manner for the most part with only minor problems with little identifiable effect on overall performance.

Fair (F) The Offeror’s performance may be limited in terms of the size, scope and complexity when compared to this acquisition, and it demonstrates meets or slightly exceeds minimum acceptable standards; adequate results; reportable problems with identifiable, but not substantial, effects on overall performance.

Poor (P) The Offeror’s performance demonstrated performance that does not meet minimum acceptable standards in one or more areas; remedial action required in one or more areas;

problems in one or more areas, which adversely affect overall performance.

Neutral (N) Assigned to offerors without a record of relevant past performance or for whom information on past performance is not available.

No PERFORMANCE QUESTIONS RATING (Please Circle)

CONTRACT MANAGEMENT

1 Effectively managed and controlled subcontractor performance

E VG G F P N

2 Effectiveness of jobsite supervision E VG G F P N

3 Compliance with technical requirements and performance standards

E VG G F P N

4 Timeliness, quality, and accuracy of schedule information E VG G F P N

5 Compliance with Labor Standards E VG G F P N

6 Delivered project that met or exceeded performance requirements within schedule

E VG G F P N

7 Implementation of Small Business Subcontracting Plan E VG G F P N

Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

E VG G F P N

9 Prompt payment of subcontractors/suppliers on a regular basis

E VG G F P N

10 Contractor meets contractual completion dates for performance

E VG G F P N

11 Complete and timely contract close out documentation (ie, Final invoice, Release of claims, as-builts, O&M manuals, warranties)

E VG G F P N

12 Low turnover of key personnel E VG G F P N

Corporate Management Responsiveness

13 Timely submission of weekly payrolls and responsiveness to contracting officer’s requests for information

E VG G F P N

14 Ability to hire and retain a qualified workforce to this effort E VG G F P N

15 Responsiveness to Government requests E VG G F P N

Technical Performance

16 Timely identification of risks/problems E VG G F P N

17 Proposed acceptable solutions to problems in a timely manner E VG G F P N

18 Complied with LEED standards and documentation to ensure LEED certification

E VG G F P N

19 Adequacy of QC Plan E VG G F P N

20 Effectiveness and responsiveness of QC Staff E VG G F P N

21 Identified and corrected deficiencies in a timely manner in accordance with their quality control procedures

E VG G F P N

22 Response to warranty issues E VG G F P N

23 Quality of Construction Work E VG G F P N

24 Timeliness, quality, and accuracy of Small Business Subcontracting Plan reporting

E VG G F P N

SAFETY

25 Adequacy of Health and Safety Plan E VG G F P N

26 Adherence to Health and Safety Plan E VG G F P N

27 Cooperation with Owner’s safety personnel E VG G F P N

28 Adherence to established security procedures E VG G F P N

29 Kept clean and orderly project site E VG G F P N

30 Accidents/incidents were reported, investigated, and appropriate corrective actions were taken

E VG G F P N

31 Contractor compliance with environmental regulations/laws E VG G F P N

Overall Contract Performance Rating (circle one):

Excellent Very Good Good Fair Poor

Please add any other comments you may feel are pertinent:

IV. Evaluator Information

Name: _____________________________________________________________

Title: _______________________________________________________________

Agency/Company: ____________________________________________________

Address: ____________________________________________________________

Email Address: _______________________________________________________

Phone: _____________________Date Questionnaire Completed: _______________

Evaluator’s Signature Date

1. Have there been any indications that the contractor has had any financial problems? If yes, please explain:

( ) Yes ( ) No

2. Has the Contractor been given any of the following: Cure notice, show cause, letters of reprimand, suspension of payments, termination? If yes, please explain:

( ) Yes ( ) No

3. a) Were there problems with the on-site supervision?

b) If so, were you able to easily resolve those problems with the company’s management? If yes, please explain:

4. Would you award another contract to this Contractor? If no, please explain: ( ) Yes ( ) No

5. What were the contractor’s greatest strengths in performance of the contract?

6. What were the contractor’s greatest weaknesses in performance of the contract?