Past_Performance_Survey_.doc

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US-Indio Pacific Standards and Technology Cooperation Program (STCP) Technical Assistance
Solicitation number
1131PL19RCP31207
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Past Performance Questionnaire

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Solicitation: US – Indio-Pacific Standards and Technology Cooperation Program (STCP) Technical Assistance (TA) Services Solicitation No.: 1131PL19RCP31207

PAST PERFORMANCE SURVEY

Please Submit Completed Survey to USTDA’s Office of Acquisition Management at Contractproposals@ustda.gov, no later than 12:00 Noon, September 6, 2019, Arlington, VA Time.

Name of Contractor Being Reviewed:

Contract Number/Reference Information:

Name of Agency/Organization Submitting Review for this Contractor:

Name of Person Completing Questionnaire
Phone Number
Email Address
Period of Performance: XX/XX/XXXX – XX/XX/XXXX
Brief Description of Services: XXXXXXXXX

Total Contract Value: $XXXX.XX

Contract Performance Information

Questions:
Response:
1. How would you rate your confidence in the contractor’s ability to comply with contract terms and conditions?
· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

· Unknown/Neutral Confidence

· No Confidence

2. How would you rate your confidence in the contractor’s ability to complete work on schedule?
· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

· Unknown/Neutral Confidence

· No Confidence

3. How would you rate your confidence in the contractor’s ability to comply with the actual requirements?
· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

· Unknown/Neutral Confidence

· No Confidence

4. How would you rate your confidence in the contractor’s ability to take appropriate corrective measures to prevent problems and/or problem reoccurrence?
· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

· Unknown/Neutral Confidence

· No Confidence

5. Would you recommend and/or do business with this contractor in the future? If your answer is No, please explain why.

· Yes

· No

Comment:

6. Were there any issues not discussed above or do you have any additional comments on the contractor’s performance that you would like to discuss?
· Yes

· No Comment:

USTDA sincerely thanks you for taking the time to complete this questionnaire and for your contribution to the success of our acquisition program.

Additional Comments:

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