Attachment 4 - Past Performance Questionnaire.docx

ATTACHMENT #4

PAST PERFORMANCE QUESTIONNAIRE

Control Number: 6973GH-18-R-00148

TO BE COMPLETED BY THE OFFEROR:

I. CONTRACT INFORMATION –

2. Contract Number: ________________________________________________________

3. Contract type: ___________________________________________________________

4. Contract Total Value: $____________________________________________________

5. Contract start-completion dates: ____________________________________________

6. Description of Work performed: _____________________________________________

TO BE COMPLETED BY THE EVALUATOR:

The Department of Transportation, Federal Aviation Administration is interested in your assessment of the named company’s performance on your contract for the purpose of utilizing this information to evaluate the contractor’s probability of successfully performing a federal government requirement that is currently being advertised. Please complete and submit no later than 3:00 pm CST on ______________.

Is the information provided above in questions 1-6 accurate and correct to the best of your knowledge?

Yes______ No_____

If “No” why not?

II. PAST PERFORMANCE EVALUATION

Please rate the Contractor as “Excellent” (E), “Good” (G), “Satisfactory” (S), and “Marginal” (M), “Unsatisfactory” (U), or “Unknown” (N/A) in the following areas:

A. QUALITY OF PRODUCT OR SERVICES

PAST PERFORMANCE QUESTIONAIRE (CONTINUED)

2. Quality of services and support provided including content and accuracy of technical, cost, or other reports.

Rating: ______

B. TIMELINESS OF PERFORMANCE

C. COST CONTROL

2. Cost overrun and change proposals submitted were reasonably priced and contained all appropriate supporting documentation.

Rating: ______

D. BUSINESS PRACTICES

1. Contractor’s skills in efficiently and effectively allocating and directing personnel and resources to meet customer needs.

Rating: ______

2. Contractor’s reasonable and cooperative behavior, flexibility, as well as their responsiveness to inquiries from your organization’s technical and contract representatives.

Rating: ______

E. CUSTOMER SATISFACTION

1. Were there any significant problems encountered by the Contractor? Yes____ No____ If yes, state the problem(s), what corrective actions were taken by the Contractor, and indicate whether you consider these corrective actions to be effective?

2. Please comment on the overall satisfaction of your organization with the contractor’s performance.

3. Additional comments both positive and negative (please address any unfavorable ratings identified from Part II above).

III. RESPONDENT INFORMATION

1. Name of Evaluator(s):_________________________________________

2. Position Title(s):______________________________________________

3. Organization Name and Mailing Address:

4. Telephone Number: _______________ Fax Number: __________________

5. Email Address: ________________________________________________

6. Date Questionnaire Completed: ___________________________________ Please return the questionnaire by any method as follows:

Mailing Address: Fax: 405-954-9219 Email: kevin.gramling@faa.gov Federal Aviation Administration

Oklahoma City, OK 73169-6901

For questions, please contact Mr. Gramling at (405) 954-3123

THANK YOU FOR YOUR TIME IN COMPLETING THIS QUESTIONNAIRE