Past Performance Questionnaire_N4215821R0002.doc

Recent and Relevant Past Performance Questionnaire – Attachment 5

1. Past Performance Assessment. The Norfolk Naval Shipyard (NNSY), Code 400 Contracting Department, is soliciting competitive proposals. NNSY is seeking proposals from potential Offerors with the capability to provide High-Quality Water Services Services.

In addition to the information requested above, offerors shall contact their past performance references, and request that each reference complete the attached “Past Performance Questionnaire Report Form” and e-mail the completed survey form directly to Denise Swain (denise.swain@navy.mil) and Cheryl Copeland (cheryl.copeland@navy.mil) no later than the closing date and time of the solicitation. The Government reserves the right to consider past performance report forms received after the due date of the solicitation and to contact references for verification or additional information

RETURN THIS COMPLETED QUESTIONNAIRE TO THE AFOREMENTIONED INDIVIDUALS.

NOTE: IT IS THE RESPONSIBILITY OF THE OFFEROR TO ENSURE ALL PAST PERFORMANCE QUESTIONNAIRES ARE SUBMITTED TO THE GOVERNMENT IN ACCORDANCE WITH THE SOLICITATION REQIREMENTS AS NEEDED.

If you need more space than what is provided, please attach additional pages. Responses will be treated as source selection sensitive information. If you have any questions, please contact the POCs listed above.

2. Contract Information. Please complete the following:

Contractor:

Contract Number:

Period of Performance:

Dollar Amount at Award:

Dollar Amount at Completion (or Current Dollar Amount, if not Completed):

Contract Type: Fixed-Price; Labor Hour or Time and Material; Cost-Reimbursement (CPFF, CPAF, CPIF, etc.)

Describe the Products or Services:

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

(a)

Size: $______ per year in contract services.

(b) Scope: Check all that apply:

______ Program Management Support

______ Planning Support

______ Business and Financial Management Support

______ Acquisition and Contract Management Support

______ Technical Management Support

______ Test and Evaluation Management Support

______ General Logistics Management Support

______ Production Management Support

______ Engineering Support

______ Other Support (please describe: _________________________)

4. Performance Assessment Values.

5 - Outstanding. Performance meets contractual requirements and exceeds many requirements, to the Government’s benefit. Contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

4 - Excellent. Performance meets contractual requirements and exceeds some requirements, to the Government’s benefit. Contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

3 – Good. Performance meets contractual requirements. Contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

2 - Satisfactory. Performance barely meets some contractual requirements. Contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.

1 - Unsatisfactory. Performance does not meet some or most contractual requirements and recovery is not likely in a timely manner. Contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

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

5. 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).

Comments:

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

Comments:

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

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.)

Comments:

e. Socioeconomic Goals. Rate the contractor’s ability to meet any applicable subcontracting goals for utilization of Small Business (SB), Small Disadvantaged Businesses (SDB), Women-Owned Small Businesses (WOSB), Service-Disabled Veteran-Owned Small Business (SDVOSB), HUBZone and Historically Black Colleges and Universities/Minority Institutions (HBCU/MI).

Comments:

f. Subcontract Management. Rate the contractor’s ability to meet the goals of the subcontracting plan, to include the ability to timely award and manage subcontracts.

Comments:

g. 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.

Comments:

h. Management of Key Personnel. Assess the contractor’s performance in selecting, retaining, supporting, and replacing—when necessary—key personnel.

Comments:

i. 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.

Comments:

6. 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:

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

Name:

Title:

Address:

Phone Number:

E-Mail Address:

Thank you for your assistance.

Source Selection Information – See FAR 2.101 and 3.104

PAGE

Source Selection Information – See FAR 2.101 and 3.104