Exhibit 13 Rev 1 - OMESIII PastPerfQues.docx

RFP 80GSFC21R0046

EXHIBIT 13 OMES III

REVISION 1,

PAST PERFORMANCE QUESTIONNAIRE

RFP 80GSFC21R0046

PAST PERFORMANCE QUESTIONNAIRE INSTRUCTIONS

(Updated May, 2018)

Sections 1-3 provide for contract-related descriptive information and identification of the evaluator.

Section 4 lists the major work elements within our Statement of Work (SOW). Please provide your assessment of the “relevant experience” and “performance” associated with our SOW evidenced within the contract for which you are a reference. “Experience” means a contractor who has performed work in the specific SOW Element. “Did not Perform” means that the specific SOW element was not performed under the contract.

S ection 5 evaluates the contractor’s technical, schedule, and cost performance and management. (Additional pages may be used for comments if desired). If you cannot answer any questions, please circle “N/R” for Not Rated.

The following definitions are offered for your use in assigning a performance rating for each of the factors in Sections 5 and 6:

Very High

(VH)

The Offeror’s relevant past performance is of exceptional merit; indicating exemplary performance in a timely, efficient, and economical manner; very minor (if any) problems with no adverse effect on overall performance.

Moderate

(M) The Offeror’s relevant past performance demonstrates effective performance; fully responsive to contract requirements; reportable problems, but with little identifiable effect on overall performance.

Low

(L) The Offeror’s relevant past performance meets or slightly exceeds minimum acceptable standards; adequate results; reportable problems with identifiable, but not substantial, effects on overall performance.

Very Low

(VL)

The Offeror’s relevant past performance 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.

Section 6 provides for evaluation of the contractor’s management of cost and award/incentive fee history.

Greenbelt, MD 20771 Phone: 301-286-3459 e-mail: tasha.williams@nasa.gov

RFP 80GSFC21R0046

PAST PERFORMANCE QUESTIONNAIRE

1. C ontract Information

A. Name of Company/Division Being Evaluated:

B. Address:_ _

C. Contractor Cage Code and/or DUNS number

D. Contract Number: _

E. Contract Type: _

F. Period of Performance (including options): From: To: _

G. Total Contract Value:_ _

2. Description of Contract

Briefly describe the services provided under this contract:

During the contract performance being evaluated, this firm was the:

Does a corporate or business relationship exist between the firm being evaluated and your organization?

Yes _ No _ . If yes, please describe:

3. E valuator Information

Name: _ Title: _ Agency/Company: _ _ E-mail Address: Phone: Date Questionnaire Completed: Role in Program/Contract: _ _ Length of Involvement in this Program/ Contract: _

P AST PERFORMANCE QUESTIONNAIRE

4. SOW Survey Relevance Ratings: Please check the appropriate blocks for Relevance (Performed or Did Not Perform)

SOW ELEMENT

SIGNIFICANT

MODERATE

MINIMAL/ DID NOT PERFORM

PERFORMANCE RATING

(Please circle)

FUNCTION 1 – Technology Development Services

Instrument Electronics Systems Technology Services

Thermal Control Systems Technology Services

Power Systems Technology Services

Guidance, Navigation and Control (GN&C) Technology Services

Cryogenic and Fluids Systems Technology Services

Robotic Technology Services

Autonomous Rendezvous and Docking Services

FUNCTION 2 – Pre-Formulation and Formulation Studies

System Definition Study Services

FUNCTION 3 – Implementation Phase Services

Mission Systems Engineering

Software Systems Engineering, Studies, Analysis and Support

Fabrication, Assembly and Testing Services

Integration, Test, and Verification Services

Mission Assurance and Systems Safety Services

EEE Parts Program Services

This form contains Source Selection Information when completed. See FAR 3.104. 4

PAST PERFORMANCE QUESTIONNAIRE

5. General Performance Survey

(Please Circle)

QUALITY

Comment:

SCHEDULE

Comment:

COST

Comment:

BUSINESS/MANAGEMENT

11.

Ability to recruit and retain highly skilled personnel, including ability to fill key vacancies in a timely manner.

VH

H

M

L

VL

N/R

Comment:

This form contains Source Selection Information when completed. See FAR 3.104.

RFP 80GSFC21R0046

PAST PERFORMANCE QUESTIONNAIRE

Section 6:

What is the Contract Value:

Fee: $ $ _

Total Value: $ $

What are the total contract expenditures to date (cost/fees to date based on invoices, reports, etc)?

What is the Annual Contract Value to Date (The current contract expenditures to date divided by the number of years of performance to date)?

For example (note, these example numbers may not relate to this specific procurement):

Assume your contract is a current five year contract, is still ongoing, and the latest cost report reflects a cost/fee of $43,500,000 through the first 2 years and 4 months (to date). In this example, current/total Contract Expenditures incurred to Date are $43,500,000 and associated period of performance for those expenditures, expressed in years, is 2.33 years.

Therefore, the Average Annual Cost/Fee Incurred to Date: $18,669,528 ($43,500,000/2.33 years)

Was there a cost overrun? ( ) Yes ( ) No If yes, please explain:

If this was an award fee contract, what are the individual and/or average ratings of performance by your organization? Please attach any available award fee letters or database entries.

Please comment on particularly strong/weak points of Contractor’s performance (technical, schedule, and/or cost). If the Overall Contract Performance Rating below is less than Very High, please provide some explanation in this section on why a higher rating was not provided.

Overall Contract Performance Rating (circle one)

Very High High Moderate Low Very Low If less than Very High Performance Rating, please explain:

Please add any other comments you may feel are pertinent.

_ Rater’s Signature Date