Past Performance Questionaire 2-24-21.doc

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.

Section 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.

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 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.

RETURN THIS QUESTIONNAIRE TO

NASA Goddard Space Flight Center

BY March 20, 2020.

Attn: Odessia Becks, Code 210

Greenbelt, MD 20771

Phone: 301-286-8386

Odessia.H.Becks@nasa.gov

PAST PERFORMANCE QUESTIONNAIRE

1.

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)_________________________

2.

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: ___________________________

3.

Evaluator Information

Name: _____________________________________________________

Title: _______________________________________________________

Agency/Company: ____________________________________________

E-mail Address: _______________________________________________

Phone: ______________ Date Questionnaire Completed: _____________

Role in Program/Contract: ______________________________________

Length of Involvement in this Program/ Contract: _____________________

PAST PERFORMANCE QUESTIONNAIRE

4.

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

SOW ELEMENT

Built multiple dilution refrigerator systems for customers in the past of the design being proposed.

Delivered dilution refrigerator systems of similar specification in the required 7-month time frame.

Installed SMA coaxial microwave readout lines from room temperature to the mixing chamber meeting the requirements in previous dilution refrigerator systems.

Installed 1550 nm optical fibers from room temperature to the mixing chamber in previous dilution refrigerator systems.

5. General Performance Survey

(Please Circle)

QUALITY

Comment:

SCHEDULE

Comment:

COST

Comment:

BUSINESS/MANAGEMENT

EXHIBIT DESIGN SKILL

Comment:

Section 6:

What is the Contract Value:

Initial Value

Current Value

Estimated Cost:

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