Addendum HH Past Performance Questionnaire.doc

Addendum HH

PAST PERFORMANCE QUESTIONNAIRE

FOR SOLICITATION NO. NRC-HQ-11-R-33-0011

REQUESTED RESPONSE: In Accordance with each Functional Area Proposal Due date.

EVALUATOR: Please complete questionnaire and email to:

MOMContract@nrc.gov OFFEROR: Complete sections I and II of this questionnaire for each company, contractor, subcontractor, entity, or team member for which you are submitting past performance information (see solicitation Section L instructions for Volume IV). For each contract/order, listed in the response to the RFP, provide one copy of this questionnaire to the Program Manager/Project Manager/COTR and one copy to the Contracts Administrator/Contracting Officer/Contract Specialist of the referenced firm or government agency for completion.

EVALUATOR: Please cross-out and correct any information that is incorrect in Sections I and II, sign the bottom of this page after completing Section II and then email the completed form as indicated in the above box.

I. IDENTIFICATION OF CONTRACTOR BEING EVALUATED [Offeror – complete this section for each contract/order]:

1. Company/Division (Contractor) Providing Services: _______________________________________

2. Address:

3. Contract/Order Number:

Dollar Value (Total (if all options exercised) and Total to date): ________________________________________________________

4. Performance Period:

Performance Location:

5. Type of Contract (Check One):

Fixed Price Cost Reimbursement Other (specify type)

6. Basis of Award (Check One):

Competitive Non-Competitive

7. Describe Type and Extent of Subcontracting (if any):

II. EVALUATED BY [Offeror – complete this Section; Evaluator - please correct any misinformation and sign]:

Company/Organization Name:

Company/Organization Address:

Evaluator’s Name and Title:

Evaluator’s Signature:

Date:

Email :

Phone:

Evaluator: Please answer questions 1 through 13 (below) using the following criteria. Circle only one response per question. For questions rated 1 (Marginal) or 0 (Unsatisfactory), please comment on the specific problem(s) or performance failure(s) that prompted this rating.

4 – Excellent - Performance met and exceeded many of the contractual requirements to the organization's benefit. The contractual performance of the element being evaluated was accomplished with few or no minor problems for which corrective actions were highly effective.

3 - Very Good - Performance met and exceeded some of the contractual requirements to the organization's benefit. The contractual performance of the element being evaluated was accomplished with some (or few or no) minor problems for which corrective actions were effective.

2 – Satisfactory - Performance met contractual requirements. The contractual performance of the element being evaluated was accomplished with some minor problems for which corrective actions were satisfactory.

1 – Marginal - Performance barely met contractual requirements. The contractual performance of the element being evaluated reflects problems, for which corrective actions have not yet been identified, appear only marginally effective or was not fully implemented.

0 – Unsatisfactory - Performance did not meet some contractual requirement and recovery is not likely in a timely manner. The contractual performance of the element being evaluated reflects serious problems for which corrective actions were ineffective.

N/A - Not applicable or not observed.

1. Rate the contractor's overall commitment to quality performance and customer satisfaction.

4 3 2 1 0 N/A

Comment:

2. Rate the contractor's overall technical competence.

4 3 2 1 0 N/A

Comment:

3. Rate the contractor's cooperation and willingness to work as a team (with your personnel, other contractors, etc.).

4 3 2 1 0 N/A

Comment:

4. Rate the contractor's compliance with contractual requirements.

4 3 2 1 0 N/A

Comment:

5. Rate the contractor's responsiveness to contract changes, changes in technical requirements and/or schedule changes.

4 3 2 1 0 N/A

Comment:

6. Rate the effectiveness of the contractor's overall quality control procedures.

4 3 2 1 0 N/A

Comment:

7. Rate the effectiveness of the contractor's management and supervision.

4 3 2 1 0 N/A

Comment:

8. Rate the contractor's ability to overcome technical problems, labor issues, and/or other performance difficulties.

4 3 2 1 0 N/A

Comment:

9. Rate the contractor ability to reframe from unreasonable or excessive change order request.

4 3 2 1 0 N/A

Comment:

10. Rate the contractor's ability to plan and conduct operations in a cost effective manner.

4 3 2 1 0 N/A

Comment:

11. Rate the contractor's ability to adhere to schedules and complete work on time.

4 3 2 1 0 N/A

Comment:

12. Rate the quality and stability of the contractor's workforce utilized on the contract/order.

4 3 2 1 0 N/A

Comment:

13. Rate the availability, adequacy, and suitability of the contractor's staffing for the work required.

4 3 2 1 0 N/A

Comment:

14. Rate the contractor’s ability to recruit new personnel for the contract/order within a reasonable period of time 4 3 2 1 0 N/A

Comment:

Thank you for your assistance in completing this Past Performance Questionnaire.

U.S. Nuclear Regulatory Commission Division of Contracts