Section L Appendix 4 - Past Performance Questionnaire.docx

NASA/KSC SOLICITATION 80KSC021R0023

APPENDIX 4

PAST PERFORMANCE QUESTIONNAIRE

Safety and Reliability Power Upgrades Phases 4 and 5, Kennedy Space Center, Florida.

NASA Kennedy Space Center’s solicitation requires offerors to provide this Past Performance Questionnaire to customers to complete and return to NASA. Past performance raters are requested to submit the completed questionnaires to the contracting officer identified below via e-mail, to arrive not later than the proposal submission date.

Completed questionnaires should be sent to:

Raters are requested to complete the questionnaire forms as written since altered or substituted questionnaires may not adequately address the information NASA will be evaluating.

SECTION I. THIS SECTION TO BE COMPLETED BY THE OFFEROR

Name of Contractor Being Evaluated: _______________________________________

Name of Project and Contract/Order Number: ________________________________

Period of Contract Performance (dates): _____________________________________

Current Contract Completion Percentage if Project is not done:____________________

Place of Contract Performance: ____________________________________________

Contract Value at Award: _________________________________________________

Contract Value at Completion or Current Contract Amount: ______________________

Contract Status (Prime or Subcontract?): _____________________________________

Point of Contact: (Rater) Name/Address/Office Phone Number/E-Mail Address: ____________________________________________________________________________________________________________________________________________________________

THIS SECTION TO BE COMPLETED BY THE RATER

(THIS QUESTIONNAIRE, WHEN COMPLETED, SHALL NOT BE DISCLOSED TO ANYONE OUTSIDE THE GOVERNMENT)

Name of Contractor Being Evaluated: _____________________________________________

Name of Project and Contract/Order Number: ______________________________________

Period of Contract Performance (dates): __________________________________________

Place of Contract Performance: _________________________________________________

Contract Value at Award: ______________________________________________________

Contract Value at Completion or Current Contract Amount: ____________________________

Contractor’s Status (Prime or Subcontractor?): _____________________________________

Percentage and Dollar Value of Work Performed by the Contractor:

Dates of Rater’s Involvement in Program/Contract: _________________________________

Brief Description of Work Performed: ___________________________________________________________________________

Point of Contact: (Rater) Name/Address/Office Phone Number/E-Mail Address: ___________________________________________________________________________

RATING DEFINITIONS:

On a scale of 1 to 5, with 1 being unsatisfactory and 5 being exceptional, please rate the contractor on the past performance areas included in this questionnaire. A rating of N/A should be used if the question is not applicable or the answer is unknown. Space is provided for any additional comments raters may want to provide. The definitions associated with the 1 to 5 ratings are provided below:

1. UNSATISFACTORY: Performance does (did) not meet most contractual requirements and recovery is not likely (did not occur). The contractual performance contains (contained) serious problem(s) for which the contractor’s corrective actions appear ineffective (were ineffective).

2. MARGINAL: Performance does (did) not meet some contractual requirements. The contractual performance reflects (reflected) serious problem(s) for which the contractor has not yet identified acceptable corrective actions (did not provide acceptable corrective actions).

3. SATISFACTORY: Performance meets (met) contractual requirements. The contractual performance reflects (reflected) some minor problems. Corrective actions being taken by the contractor appear to be effective (Corrective actions taken were effective).

4. VERY GOOD: Performance meets (met) contractual requirements and exceeds (exceeded) some of the Government’s expectations. The contractual performance reflects (reflected) some minor problems and corrective actions being taken by the contractor appear to be effective (Corrective actions taken were effective).

5. EXCEPTIONAL: Performance meets (met) contractual requirements and exceeds (exceeded) many of the Government’s expectations. The contractual performance reflects (reflected) few minor problems and corrective actions taken by the contractor appear to be highly effective (corrective actions taken were effective).

N/A: Not applicable or rater has not observed performance in this area.

CONTRACTOR’S TECHNICAL PERFORMANCE QUESTIONS

1. The effectiveness of the Contractor’s overall project management ability (including but not limited to project managers, quality control managers, trade integrators, safety managers, and superintendents); labor (skilled and unskilled workers); equipment; supplies; tools; and financial resources to successfully perform, provide contract deliverables and complete work in a safe and timely manner.

Comments:

2. The Contractor’s ability to provide immediate and effective contractor management attention at the job site and partner with the owner to resolve technical and schedule issues.

Comments:

3. The Contractor’s ability to provide quality engineering shop drawings and accurate and complete as-built documentation.

Comments:

4. The Contractor’s ability to complete work within the required timeframe(s).

Comments:

5. The Contractor’s ability to coordinate and complete major electrical distribution equipment work during critical outage windows.

Comments:

56. The Contractor’s ability to safely and successfully implement major electrical distribution equipment modifications in areas remaining operational during the construction process.

Comments:

67. The Contractor’s ability to resolve safety discrepancies in a timely and effective manner and the ability to report, investigate, and take corrective actions on safety accidents/incidents in a timely and effective manner

Comments:

CONTRACTOR’S CONTRACT ADMINISTRATION PERFORMANCE QUESTIONS

78. The contractor’s ability to provide prompt payment of employees, subcontractors, and suppliers for services and supplies performed/delivered under the contract.

Comments:

89. The contractor’s compliance with Department of Labor requirements and resolution of reported violations/discrepancies.

Comments:

910. Has the contractor’s performance required the issuance of any cure notices, show cause letters, or terminations for cause/default? (Please circle Yes or No)

Comments:

CONTRACTOR’S OVERALL CONTRACT PERFORMANCE

110. Would you select this contractor again? (Please circle Yes or No)

Comments:

THIS COMPLETED QUESTIONNAIRE WILL NOT BE DISCLOSED TO ANYONE OUTSIDE THE GOVERNMENT. THANK YOU FOR TAKING THE TIME TO COMPLETE THIS QUESTIONNAIRE.