6973GH-22-R-00135_Attachment 04_Organizational Experience and Past Performance Form.docx

OFFEROR EXPERIENCE INFORMATION

(To be completed by Offeror)

1. Offeror: Name:

Address:

2. Contract /Task Order(TO) /Purchase Order (PO) Number:

3. Contract/TO/PO Dollar Value:

4. Contract/TO /PO Status: Active ( ) Complete ( ) Completion Date (w/ extensions):

5. Project Title: Location:

6. Project Description-- to include the role of the offeror on the project and specific responsibilities of the offeror in performance of the effort:

7. Project Owner or Project Manager for the Client – provide: Name:

Address:

Telephone Number and E-mail:

PLEASE SEND TO CUSTOMER IDENDTIFIED IN BLOCK 7 TO COMPLETE REMAINDER OF THIS FORM WITH REQUEST TO RETURN TO THE RESPONSIBLE POC NLT THE CLOSING DATE OF THE ANNOUNCEMENT.

SIR #6973GH-22-R-00135

Attachment 4 Organizational Experience & Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

(To be completed by Contract’s Customer)

Instructions: Please type an ‘X’ in the appropriate blocks in response to the respective questions based on your experience with this vendor during the performance of the contract referenced in the page above.

Please include a brief explanation for any responses of UNACCEPTABLE in the notes line provided.

You may fill out this document electronically or in writing (ink).

1. Quality

a. How would you rate the contractor’s general overall compliance with contract requirements (quality of work)?

ACCEPTABLE ( )

UNACCEPTABLE ( )

NOTES:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2, Timeliness

a. How would you rate the timeliness of the contractor’s service with regards to the contract’s delivery schedule (deliver on time)?

ACCEPTABLE ( )

NOTES:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Cost Control

a. How did the contractor complete all work within the confines of the contract’s funding obligation and agreement on cost/price (deliver on cost)?

ACCEPTABLE ( )

NOT APPLICABLE ( )

NOTES:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

NAME:____________________________

TITLE: ____________________________

ORGANIZATION: __________________

DATE: ____________________________

SIGNATURE:

THANK YOU FOR YOU PARTICIPATION!

Upon completion, please return this form via email to the following email address: joshua.d.huckeby@faa.gov no later than 1700 (Central) on 31 July, 2022.