Section L Appendix 4 - Past Performance Questionnaire.docx

NASA/KSC SOLICITATION 80KSC020R0001

SECTION L - APPENDIX 4

PAST PERFORMANCE QUESTIONNAIRE

Modify VAB High Bay 3 Platforms for SLS Block 1B, Kennedy Space Center, FL.

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.

NOTE: The references provided must be relevant to the type of work required in the above project and those questionnaires with comments may be deemed more relevant due to the additional information provided in the comments, so please provide comments.

Return completed questionnaires, by e-mail, to Anthony.M.Caruvana@nasa.gov

NOTE: Questionnaires will not be accepted from the offeror. Raters must send evaluation to the contracting officer.

TO BE COMPLETED BY THE OFFEROR:

Name of Contractor Being Evaluated:_______________________________________

Name of Client: ________________________________________________________

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: ______________________

Contract Status (Prime or Subcontract?): ___________________________________

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

Brief Description of Work Performed:

TO BE COMPLETED BY RATER:

This questionnaire, when completed, shall not be disclosed to anyone outside the Government.

Name of Contractor being evaluated: _________________________________

Prime or Subcontractor?____________________________________________

Name of Project and Contract / Order Number: _________________________

Contract Type (Firm Fixed Price, Cost, etc.): ___________________________

Place of Contract Performance: _____________________________________

Concur with Offeror’s Description of Work Performed? Yes No

If no, please describe the work: ______________________________________

Period of Performance: ____________________________________________

Contract or Subcontract Value at Award: $_____________________________

Contract or Subcontract Value at Completion or Current: $_________________

PLEASE FILL IN THE FOLLOWING RESPONDENT INFORMATION

Names of Evaluator(s): _____________________________________________

Office Symbol and Organization: _____________________________________

Telephone: ______________________________________________________

E-mail address: __________________________________________________

Dates of Involvement in Project/Contract: _____________________________

Date Questionnaire Completed: _____________________________________

For each question below, please rate the contractor from Poor to Excellent (as defined below) and please elaborate on the specifics, which explain your rating. A rating of N/A should be used if either the question is not applicable or the answer is unknown. This rating is neutral and will have no impact on the assessment of Present and Past Performance. The Contracting Officer may contact the respondent for additional information, if needed. When rating the contractor per the statement’s below, choose “N/A” or a number on the scale from 1 to 5 (with 1 being Poor and 5 being Excellent”, which most accurately describes the contractor’s performance. The scale is as follows:

1. POOR: 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. Based on the offeror’s performance record, there is very low confidence that the offeror will successfully and safely perform the required effort

2. FAIR: Meets or slightly exceeds minimum acceptable standards; adequate results; reportable problems with identifiable, but not substantial, effects on overall performance; and experience is at least somewhat relevant to this procurement. Based on the offeror’s performance record, there is low confidence that the offeror will successfully and safely perform the required effort. Changes to the offeror’s existing processes may be necessary in order to achieve contract requirements.

3. GOOD: Effective performance; fully responsive to contract requirements; reportable problems, but with little identifiable effect on overall performance; and experience is relevant to this procurement. Based on the offeror’s performance record, there is confidence that the offeror will successfully perform the required effort. There may be strengths or weaknesses, or both.

4. VERY GOOD: Very effective performance; fully responsive to contract requirements; contract requirements accomplished in a timely, efficient, safe and economical manner for the most part; only minor problems with little identifiable effect on overall performance; and experience is very relevant to this procurement. Based on the offeror’s performance record, there is a high level of confidence that the offeror will successfully perform the required effort.

5. EXCELLENT: Of exceptional merit; exemplary performance in a timely, efficient, safe and economical manner; very minor (if any) problems with no adverse effect on overall performance; and experience that is highly relevant to this procurement. Based on the offeror’s performance record, there is a very high level of confidence that the offeror will successfully perform the required effort.

6. N/A: Not applicable or unknown: Did not observer performance in this area.

1. In regards to performance, rate the contractor's adherence to the technical requirements of the contract:

Steel Fabrication to stringent Tolerances 1 2 3 4 5 N/A Welding Documentation (Procedures, Welder Qualifications,

Integration of trades such as High pressure piping, electrical power, fire sprinklers and fire alarm 1 2 3 4 5 N/A

COMMENTS/REMARKS: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

COMMENTS/REMARKS: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. In terms of their performance in meeting schedules, how would you rate them in the following areas?

Submission of Shop Drawings/ Material Submittals 1 2 3 4 5 N/A Scheduling construction around facility

Progress Reports of actual versus planned schedule 1 2 3 4 5 N/A

COMMENTS/REMARKS: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Overall performance of the Management Team

Preparation for and

Management and integration of

COMMENTS/REMARKS

5. In terms of timely response to problems/issues during performance and ability to avoid unnecessary schedule delays, how would you rate the contractor?

Proposed acceptable solutions in a

COMMENTS/REMARKS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. How would you rate their response to providing necessary documentation?

Provided adequate information and pricing and schedule data for modifications 1 2 3 4 5 N/A Provided timely close out documentation (e.g., release of claims, O&M manuals, warranties) 1 2 3 4 5 N/A Accuracy and completeness of documentation 1 2 3 4 5 N/A

COMMENTS/REMARKS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7. Any known payment problems to the subcontractors, suppliers or manufacturers?

Yes( ) No( ) N/A( )

If YES, please explain: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. Any known labor violations (Davis Bacon Act) or labor claims?

Yes( ) No( ) If YES, please explain: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. Ability/Willingness to identify and resolve problems in:

a. Management (relative to the contract)

e. Flexibility and Cooperation with Customer Operations 1 2 3 4 5 N/A

COMMENTS/REMARKS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10. Contractor corrected deficiencies in a timely manner, pursuant to their quality control procedures, and without significant reliance on Government or industry customer oversight. 1 2 3 4 5 N/A

COMMENTS/REMARKS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

11. Contractor quality control procedures 1 2 3 4 5 N/A

COMMENTS/REMARKS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

12. Contractor’s overall construction quality 1 2 3 4 5 N/A

COMMENTS/REMARKS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

13. Has the contractor’s performance required you to issue to this contractor any cure notices/show cause, or termination for cause or for default: (If YES, please explain). Yes( ) No( )

COMMENTS/REMARKS ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

14. How would you rate their OVERALL safety performance?

Overall Rating 1 2 3 4 5 N/A

Any safety violations, mishaps or close calls?

(If YES, please explain). Yes( ) No( ) N/A( )

COMMENTS/REMARKS

15. How would you rate their OVERALL performance based on customer satisfaction?

Overall Rating 1 2 3 4 5 N/A

COMMENTS/REMARKS

16. Would you select this contractor again? ( ) YES ( ) NO

COMMENTS/REMARKS

ANY ADDITIONAL COMMENTS/REMARKS ON MATTERS NOT ASKED ABOVE:

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