Attachment L-2 Past Performance Survey Form Final.docx

SIR 693KA7-25-R-00001

Surface Movement Radar, Model 4 (SMR4) Section L, Attachment-2

SMR4 Attachment L-2 Past Performance Survey Form

INSTRUCTIONS TO OFFERORS SENDING REFERENCE SURVEY FORMS:

Section A (Part I and Part II) must be completed by the Offeror (the firm requesting the reference) prior to issuing the surveys. The Offeror must ensure past performance surveys are completed for each of the past performance submittals as part of SIR Volume III. The Offeror must send the surveys for relevant past performance to the individuals who complete the survey form. For Government contracts, send to the Contracting Officer (CO) or CO’s Representative/Technical Representative (COR/COTR). For commercial references, send to personnel with duties similar to those for Government contracts. It is the responsibility of the Offeror to follow-up and encourage references to submit the survey. The completed survey must be submitted via e-mail directly from the person providing the reference by no later than the Offeror Proposals Due Date listed in SIR Section L.5.1.

INSTRUCTIONS TO PERSON PROVIDING REFERENCE:

To assess Offeror past performance as part of the Federal Aviation Administration’s (FAA) Surface Movement Radar, Model 4 SIR, the FAA contracting office is obtaining past performance information with respect to each Offeror. Please note that by soliciting survey responses from its customers, the Offeror waives rights to review the contents of this survey. As a reference for work performed by the firm identified in Section A of this survey, your candid response will assist in the evaluation process. If you are not the most knowledgeable person, please solicit input from other appropriate personnel and provide their names and contact information in your response. Please complete Section B (Part I and Part II) of the survey as thoroughly as possible and submit to Patrick.Weare@faa.gov and Aleksandra.Skoric@faa.gov no later than the Offeror Proposals Due Date listed in SIR Section L.5.1. The subject line in the submission e-mail must clearly indicate: SMR4 Past Performance Survey Submission for (Offeror name cited in Section A) and the message must originate from the reference’s government or commercial e-mail system. Your timely response is important and has a direct bearing on the Offeror’s evaluation. Therefore, your response by the aforementioned time/date is appreciated.

In addition to this survey, you may receive a follow-up to confirm or clarify information. This is a major FAA acquisition and your input into this evaluation is greatly appreciated. If you have questions regarding this survey or require assistance, please submit inquiries to:

· Patrick Weare at Patrick.Weare@faa.gov or call 202-267-5483

· Aleksandra Skoric at Aleksandra.Skoric@faa.gov or 202-267-0774.

Sincerely, Aleksandra Skoric Contracting Officer

SECTION A

TO BE COMPLETED BY OFFEROR (THE FIRM REQUESTING THE REFERENCE)

PART I: SMR4 OFFEROR INFORMATION

COMPANY NAME OF SMR4 OFFEROR:

OFFEROR ADDRESS:

COMPANY NAME OF SMR4 PERFORMING TEAM MEMBER FOR THIS REFERENCE (IF APPLICABLE):

TEAM MEMBER ADDRESS:

PART II: PAST PERFORMANCE INFORMATION

TITLE OF PROJECT/CONTRACT NUMBER FOR WHICH REFERENCE IS REQUESTED:

AGENCY/CUSTOMER

CONTRACT/ORDER/SUBCONTRACT/OTHER:

CONTRACT TYPE: (Check all that apply)

|_| FFP |_| CPFF-Completion |_| CPFF-Term |_| CPIF |_| CPAF |_| IDIQ/Task Order

|_| Requirements |_| Labor-Hour |_| T&M |_| CR |_| Other (Specify) _______________

DATE OF AWARD:

PERIOD OF PERFORMANCE (INCLUDING OPTIONS):

CONTRACT AMOUNT:

· INITIAL CONTRACT DOLLAR VALUE (W/OPTIONS):

· FINAL CONTRACT DOLLAR VALUE (W/OPTIONS):

ROLE ON PROJECT:

|_| PRIME

|_| SUBCONTRACTOR (EXPLAIN TYPE AND EXTENT OF SUBCONTRACTING, IF APPLICABLE):

|_| OTHER (EXPLAIN)

GENERAL DESCRIPTION OF SCOPE OF WORK AND THE TYPE OF PRODUCTS/SERVICES REQUIRED UNDER THE CONTRACT

DESCRIBE COMPLEXITY OF WORK AND RELEVANCY TO FAA SMR4 SIR REQUIREMENTS:

SECTION B

TO BE COMPLETED BY EVALUATOR (PERSON PROVIDING REFERENCE)

PART I: REFERENCE INFORMATION

NAME & TITLE:

ORGANIZATION (INCLUDING AGENCY AND/OR COMPANY):

CONTRACT ROLE (e.g. CO, COR/COTR):

ADDRESS:

PHONE NUMBER:

E-MAIL:

PART II: INFORMATION ABOUT PROJECT/CONTRACT FOR WHICH REFERENCE IS REQUESTED

Please identify and correct any information that is not accurate in Section A.

With regard to the above referenced contract, please select one answer, which best describes the Contractor’s performance in delivering quality products and services. Please rate each using the following scale:

1 = Not Meeting 2 = Meeting 3 = Exceeding 4 = Far Exceeding N/A = Not Applicable For any rating of 1 (Not Meeting) or 4 (Far Exceeding), please provide comments to support the rating.

PART II-2. Using the same rating scale, please select one answer, which best describes the Contractor’s performance in achieving program objectives.

(Past Performance Survey, continuation) PART II-3. Additional Information with regard to Contractor’s ability to achieve program objectives.

aa. If there was significant cost escalation in the contract, please explain the reason for the variance.

bb. If there was a significant change in the delivery schedule, please explain the reasons.

cc. What are the contractor’s weak points?

dd. What are the contractor’s strong points?

Comments: (use additional Sheets if required):

ee. Please answer the following questions and elaborate above in (aa.) – (dd.), if required:

Given the choice/authority, I would hire this contractor again?

I would recommend this contractor for other Government contracts.

I have attached additional comments regarding the contractor’s performance.

PART IV. Respondent Information:

Contracting Officer’s Name and Telephone Number

Technical Officer’s Name and Telephone Number

Signature of Evaluator

Position/Title/Grade

E-Mail Address

Phone Number

Length of involvement with Contractor (in years)