Attachment_F_-_Relevant_Experience_and_Past_Performance_Questionnaire.pdf

NASA Glenn Research Center Request for Proposals for Medical and Fitness Services

Solicitation No. NNC18ZQS01R

Relevant Experience and Past Performance Questionnaire (Attachment F)

Your assistance is requested in providing an evaluation of experience and past contract performance in support of Solicitation No. NNC18ZQS01R for NASA Glenn Research Center Medical and Fitness Services.

Please provide explanatory narratives for as many questionnaire items as possible.

Narratives should include a description of the requested service or situation as well as specific information about the offeror’s strengths and weaknesses in each area. These narratives need not be lengthy, but detailed information is most helpful. If a specific questionnaire item is not applicable to the offeror’s experience on the contract being evaluated, please indicate clearly (with “N/A” or equivalent).

Please complete this questionnaire electronically and email it as an attachment directly to:

NASA Glenn Research Center Valerie Daniel, Contracting Officer 21000 Brookpark Road, MS 60-1 Cleveland, OH 44135 Valerie.d.daniel@nasa.gov

The completed questionnaire must be received by the NASA Glenn Research Center no later than Friday, June 29, 2018, 4:30 PM EST. Respondents are requested to submit one completed questionnaire per contract.

The information provided in response to this questionnaire is considered sensitive and cannot be released to the Offeror.

If you have any questions about the acquisition or this questionnaire, please direct your questions, via email, to the GRC Contracting Officer, Valerie Daniel, at Valerie.d.daniel@nasa.gov

This questionnaire relates to an on-going source selection. All information provided will be safeguarded against unauthorized disclosure.

Thank you for your assistance.

Evaluator Information

1 Name of customer organization completing questionnaire

2 Technical point of contact

3 Title

4 Role on subject contract

5 Length of involvement

6 Phone number

7 Email address

8 Contractual point of contact (e.g., Contracting Officer)

9 Title

10 Role on subject contract

11 Length of involvement

12 Phone number

13 Email address

14 Name(s) of individual(s) completing questionnaire

Key Contract Data 15 Identity of Contractor organization(s) providing services (include name of specific Division or subsidiary)

16 Contract number or other ID

17 Total contract value over performance period specified in # 18.

18 Contract performance dates

19 Location(s) of worksites where Contractor performed work under this contract

20 Was the Contractor the prime, a team member but not the prime, or a subcontractor?

21 Total size of the Contractor’s workforce (number of staff members and full-time-person-equivalence)

22 Client population (total size, nature and demographics)

26 Nature of contract award (initial, follow-on, renewal)

27 Provide a description of the contract scope.

Technical Experience and Performance Please provide a description of the contract-provided service as well as specific information about the Contractor’s strengths and weaknesses in each area. If not applicable to the contract being evaluated, please so indicate (e.g., “N/A”).

28 Operation of a Medical Clinic

29 Operation of a Fitness Facility

30 Provision of preventive medicine services (routine physical examinations, health screenings, international travel medical clearance examinations, medical referrals)

31 Provision of emergency and therapeutic medicine services (medical care for acute occupational and non-occupational injury and illness)

32 Provision of occupational medical services (medical surveillance and monitoring evaluations associated with OSHA compliance for workplace exposure standards, examinations for occupation-related certifications, FAA flight evaluations)

33 Provision of physical fitness programs and services (exercise/fitness classes, fitness screenings/evaluation, exercise prescriptions, strength conditioning and rehabilitation services, personal training services, management of intramural sports teams/leagues, fitness challenges, motivational programs and other fitness events and programs)

35 Provision of Health Promotion and Wellness Programs (educational and awareness programs, classes, lectures on health and wellness topics, nutrition counseling, health challenge and motivational programs, weight loss and smoking cessation programs, first aid training, health and safety fairs, and health/wellness support group facilitation)

36 Provision of emergency medical response, plan, and exercise for mass casualties associated with disasters and violence and/or healthcare services associated with public health crises

38 Provision of epidemiological studies to investigate possible link between workplace conditions and illness or disease trends identified during occupational medical monitoring or health screening evaluations.

Management Experience and Performance

Please check the applicable box to indicate general level of performance, and provide specific information about the Contractor’s strengths and weaknesses in each area. If not applicable to the contract being evaluated, please so indicate (e.g., “N/A”).

39 Relationship between Contractor and other team members or partners Indicate one: Excellent Very good Good Fair

40 Problem resolution ability

41 Customer interaction and customer satisfaction

42 Ability to respond to fluctuations in demand for services

43 Accuracy and appropriateness of medical records management

44 Timeliness, accuracy and content of contract reports

45 Accomplishment of schedule and timeliness goals

46 Safety and health performance

47 Environmental compliance

48 Terminations

Cost Performance Please check the applicable box to indicate general level of performance, and provide specific information about the Contractor’s strengths and weaknesses in each area. If not applicable to the contract being evaluated, please so indicate (e.g., “N/A”).

49 Availability of, and access to, corporate financial and personnel resources

50 Cost overruns

51 Cost efficiency of operations

52 Management and control of subcontract costs

Overall Evaluation

53 Would you contract with this company again?

54 Please provide an overall rating for this Contractor.