Attachment 14 - Past Performance Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

This evaluation should be completed by the Contracting Officer (CO) and Contracting Officer Representative (COR), Task Monitor (TM), or other person identified in the contract by the appropriate CO or business manager with monitoring the Contractor’s compliance with the requirements of the contract.

In compliance with the direction in the FAR, the information contained in this evaluation is not subject to view by anyone other than the designated source selection evaluation personnel.

INSTRUCTIONS, DEFINITIONS, AND RATING GUIDELINES

Instructions

This evaluation is to be completed as indicated below. For purposes of these evaluations, the term “project” is intended to mean “contract”. This package consists of the following:

For each contract selected, one assessment is required by the appropriate CO or COR.

In addition, the Offeror is responsible for completing Section I before forwarding the questionnaire to the appropriate CO for the evaluations required. The Offeror shall request the CO to complete the remainder of the questionnaire and email them directly to the Source Evaluation Board (SEB) at the email address specified below on or before February 3, 2022

Solicitation Number 80NSSC22R0001

Any questions you might have concerning completion of this form should be addressed to Shan Black at Shanjaril.L.Black@nasa.gov.

CONTRACTOR PERFORMANCE REPORT

Section I

To be completed by Contractor requesting evaluation

1. Contractor Name and Address:

2. Name of Prime Contractor/Joint Venture/Teaming arrangement submitting proposal on this effort:

3. This past performance questionnaire is relevant to the following PWS Scope (select all that apply):

____ Internships and Fellowships ____ Awards and Grants ____ STEM Content and Products ____ STEM Engagement Recruitment ____ Workforce and Career Learning Experiences ____ K-12 STEM Engagement ____ K-16 Educators Professional Development ____ Collegiate Competitions and Challenges ____ Institutional Support for Research and Development Opportunities ____ Performance Assessment and Evaluation Services ____ Contract Management and Administration

4. Contractor DUNS Number:

5. Contractor Cage Code:

6. During the contract performance being evaluated, this firm was a:

_____ Prime or Team Lead _____ Team Member ____Other (explain)

If the firm performed work under this contract as a team member, information about the teaming arrangement, in addition to the prime information, shall be provided in the following blocks:

7a. Prime Contract Number:

7b. If the prime contract number is a BPA or IDIQ, list the TO(s) number under which the team member effort was performed:

7c. Prime Contract Period of Performance:

7d. Team Member Period of Performance:

8a. Prime Contract Type:

8b. Team Member contract type:

8c. Contract Value (with options):

8d. Team Member contract value:

9. Contract name and description of contract requirements.

Section II

To be completed by Government and/or Industry Customer performing the evaluation

1. Evaluator’s Name:

2. Evaluator’s Title:

3. Evaluator’s Email Address:

4. Evaluator’s Phone Number:

5. Evaluator’s Role in Program/Contract:

6. Evaluator’s Length of Involvement in this Contract:

7. Date:

ATTACHMENT J-3 RFP 80NSSC21R0009

80NSSC22R0001 Attachment 14 – Past Performance Questionnaire

ATTACHMENT J-3

ATTACHMENT 14│ Page 2

CONTRACTOR PERFORMANCE REPORT

Section III

To be completed by Government and/or Industry Customer performing the evaluation

Rating Guidelines

Each criterion should be assigned a rating from the chart below of “Acceptable” or “Unacceptable”. If a particular criterion is not applicable, it should be rated in the far right column as N/A. However, the evaluator is encouraged to provide comments on any rating to further support a particular rating.

Also, please ensure that this assessment is consistent with any other assessments that have been done for the same Contractor for the same work.

Item

Unacceptable

PAST PERFORMANCE QUESTIONNAIRE FORM

Section III (Cont’d)

NARRATIVE SUMMARY (Use this section to explain additional information not included above)

PAST PERFORMANCE FORM LETTER EXAMPLE

This form letter is provided for Offerors to use in transmitting the Past Performance Questionnaire to customers.

RFP 80NSSC22R0001 NSTEM Services

CLIENT AUTHORIZATION LETTER: FORMAT

[Date of Letter] [Name and Address of proposed Offeror’s customer] Attention: [Name and Designation of Customer’s Contract Manager or Appropriate Contact]

Dear [Contact Name]:

We are currently responding to the NASA Shared Services Center Request for Proposal (RFP) 80NSSC22R0001. NASA is requesting that clients of entities responding to their RFP be identified and their participation in the evaluation process requested. In the event you are contacted for information on work we have performed, you are hereby authorized to respond to those inquiries. Your cooperation with this effort is greatly appreciated. Please direct any questions to [Name and Phone Number of Offeror’s Point-of-Contact].

We have included our work for your agency as a past performance reference. A Past Performance Questionnaire is enclosed. Please complete Sections II and III of the enclosed evaluation and return the completed document to the address specified below or via email to Shan Black at Shanjaril.L.Black@nasa.gov.

NASA Shared Services Center

Please forward the completed evaluation to NASA at the above address to ensure it is received prior to February 3, 2022.

In order to maintain the integrity of this process, please DO NOT return the questionnaire to us. Return it to NASA Shared Services Center at the email address listed above.

Sincerely, [Name of Signer] [Designation of Signer