Exhibit_17_PastPerfQues.pdf

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

PAST PERFORMANCE QUESTIONNAIRE INSTRUCTIONS

(Updated September, 2010)

Sections I through III provide for contract-related descriptive information and identification of the evaluator.

Section IV 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. Your assessment of the relevancy should reflect the fact that the principal purpose of our contract is to provide facilities operations and maintenance services to the NASA/Goddard Space Flight Center

“Significant Experience” means that a full range of services was routinely performed by the contractor under the associated SOW element. “Moderate Experience” describes a contractor who has experience in several aspects of a work element even though the experience may not have been on a continuous basis or directly related to the purpose of our contract. “Minimal Experience/Did not Perform” means that, although at least some aspects of the work may have been performed, such performance was limited in scope or frequency, or the work element was not performed under the contract.

Section V evaluates the contractor’s technical, schedule, and cost performance and management. (Additional pages may be used for comments if desired). It is very important to keep in mind that only performance in the past 3 years is relevant. 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 IV and V:

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.

High

(H)

The Offeror’s relevant past performance demonstrates very effective performance that would be fully responsive to contract requirements with contract requirements accomplished in a timely, efficient, and economical manner for the most part with only minor problems with little identifiable effect on overall performance.

Moderate

(M)

The Offeror’s relevant past performance t 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.

N/R Not Rated

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

RETURN THIS QUESTIONNAIRE TO NASA Goddard Space Flight Center BY Carol Wooten. Attn: Carol Wooten, Code 210.

Greenbelt, MD 20771 Phone: 301-286-5041 e-mail: Carol.R.Wooten@nasa.gov

PAST PERFORMANCE QUESTIONNAIRE

I. Contract 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:_____________________________________

H. Award Information: Competitive: Yes___ No___ Basis of Selection: Technical___ Cost/Price___ Other (specify)_________________________

II. Description of Contract

Briefly describe the services provided under this contract:

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

Prime Contractor____ Significant Subcontractor ____ Team Member ____ Other (describe)____________________________________________

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

Yes ___ No ___. If yes, please describe: ___________________________

III. Evaluator Information

Name: ____________________________________________________ Title: ____________________________________________________ Agency/Company: ____________________________________________ Address: __________________________________________________ Phone: ______________ Date Questionnaire Completed: _______________ Role in Program/Contract: _____________________________________ Length of Involvement in this Program/ Contract: _____________________

IV. SOW Survey: Relevant Experience and Performance Ratings: Please check the appropriate blocks for both Relevance (Significant, Moderate, Minimal/Did Not Perform) and the Performance (VH, H, M, L, VL, N/R) for each SOW Element Listed below (see page 1 definitions and instructions).

SOW ELEMENT

SIGNIFICANT

MODERATE

MINIMAL/

DID NOT

PERFORM

PERFORMANCE RATING

(Please circle)

Provide preventive maintenance for institutional equipment.

VH H M L VL N/R

Repair institutional equipment. VH H M L VL N/R

Provide overall facilities operations. VH H M L VL N/R

Use Reliability Centered Maintenance (RCM) technology to predict issues

VH H M L VL N/R

Operate a 24/7/365 Facilities Console VH H M L VL N/R

Provide critical mission support VH H M L VL N/R

Provide Institutional planning VH H M L VL N/R

Operate & maintain large chiller and boiler plants VH H M L VL N/R

Perform chemical treatment of plants, building closed loop systems, and provide water chemical analysis.

VH H M L VL N/R

Remove snow and ice VH H M L VL N/R

Repair and replace roofs VH H M L VL N/R

Provide maintenance of high voltage equipment VH H M L VL N/R

Provide timely and accurate cost management VH H M L VL N/R

VH H M L VL N/R

V. General Performance Survey

NO PERFORMANCE QUESTIONS

PERFORMANCE RATING

(Please Circle)

1.

Overall performance in planning and controlling the program

VH H M L VL N/R

2. Quality of services and support provided VH H M L VL N/R

3.

Compliance with technical requirements and performance standards

VH H M L VL N/R

4.

Content, accuracy, quality, and timeliness of technical reports and deliverables

VH H M L VL N/R

5.

Ability to design and/or deliver a product that meets or exceeds performance requirements within costs and schedule

VH H M L VL N/R

6. Timely identification and mitigation of risks VH H M L VL N/R

7.

Contractor’s ability to identify and correct performance deficiencies in a timely manner

VH H M L VL N/R

8.

Compliance with technical process and control requirements (quality assurance, configuration management, etc.)

VH H M L VL N/R

9.

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

10. Ability to handle fluctuating workloads VH H M L VL N/R

11. Adherence to safety and health procedures VH H M L VL N/R

12. Overall Safety and Health injury/illness record VH H M L VL N/R

13.

Demonstrated understanding and compliance with mission safety requirements

VH H M L VL N/R

14. Communicating and interfacing with Government VH H M L VL N/R

15.

Ability to effectively manage subcontractor performance

VH H M L VL N/R

16.

Ability to build effective working relationships with associate contractors, subcontractors and the Government in a team environment.

VH H M L VL N/R

17.

Timeliness, quality, and accuracy of schedule reporting

VH H M L VL N/R

18.

Adequacy of Contractor’s system(s) for processing task orders and/or changes.

VH H M L VL N/R

19. Overall responsiveness to Government requests VH H M L VL N/R

20. Ability to establish realistic cost estimates VH H M L VL N/R

21. Ability to establish realistic schedule estimates VH H M L VL N/R

22.

If performance based, how successful was the Contractor in meeting the contract metrics?

VH H M L VL N/R

23.

Adherence to estimated costs and contract cost targets

VH H M L VL N/R

24. Ability to adhere to Environmental regulations VH H M L VL N/R

25.

Ability to anticipate, identify and control cost growth.

VH H M L VL N/R

26.

Ability to meet Small Business Subcontracting Plan Goals

VH H M L VL N/R

27.

Timeliness, quality, and accuracy of Small Business Subcontracting Plan reporting

VH H M L VL N/R

28.

Ability to meet Small Disadvantaged Business Participation targets

VH H M L VL N/R

29. Overall evaluation of cost performance VH H M L VL N/R

Section VI:

What is the Contract Value:

Initial Value Current Value Estimated Cost: $___________ $____________

Fee: $___________ $____________

Total Value: $___________ $_____________

Briefly describe any change(s) from original contract 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)?

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).

Overall Contract Performance Rating (circle one)

Very High High Moderate Low Very Low

Would you select this Contractor Again? ( ) Yes ( ) No

Please add any other comments you may feel are pertinent.

Rater’s Signature Date