Past Performance Survey- Form.doc

PAST PERFORMANCE SURVEY

The Federal Aviation Administration has requested past performance for an opportunity and you were selected as a performance reference. It would be greatly appreciated if you would complete the following information and return to me via e-mail at xxxx@xxx.com at your earliest convenience.

POC:

FAA Solicitation:

1. Contractor Name:

2. Contract Number:

3. Contractor Address:

4. Contract Type:

Firm Fixed Price

Cost Reimbursement

Other (Please Specify)

5. Your Agency Name:

6. Your Agency POC/email:

7. Completion Date:

8. Dollar Amount of Award:

Total Dollar Value with Mods:_________

9. Title of Contract:

10. Description of Contract Service:

11. Type of Work: Construction

NOTE: 1-Unsatisfactory 2- Marginal 3-Satisfactory 4-Good 5-Outstanding If Not Applicable, just write in N/A

***Please provide additional comments below for ratings of 4 and below.

1. Did the contractor commit adequate resources in timely fashion to the contract to meet the requirements and to successfully solve problems?

1( 2( 3( 4( 5(

2. To what extent did the contractor respond positively and promptly to technical direction, contract change orders, etc.?

1( 2( 3( 4( 5(

3. How reliably did the contractor follow through on commitments?

4. To what extent did the contractor’s management system provide visibility into problems and risks?

1( 2( 3( 4( 5(

5. How responsive do you think the contractor was to information requests, issues, or problems during the course of the contract?

6. How effective has the contractor been in identifying user requirements?

7. To what extent did the contractor have the ability to administer and manage the contract?

8. To what extent did the contractor issue professional correspondence?

9. How well did the contractor adhere to the Statement of Work?

1( 2( 3( 4( 5(

10. What was your level of satisfaction with the contractor’s management and support staff?

1( 2( 3( 4( 5(

11. What was your level of satisfaction with the contractor’s Supervisor(s)?

1( 2( 3( 4( 5(

12. To what extent did the contractor submit required reports and documentation in a timely manner?

1( 2( 3( 4( 5(

13. To what extent were the contractor’s reports and documentation accurate and complete?

1( 2( 3( 4( 5(

14. To what extent was the contractor’s maintenance and problem tracking/reporting documentation timely, accurate and of appropriate content?

15. To what extent did the contractor comply with safety requirements?

16. What was your level of satisfaction with the contractor’s overall quality of service?

1( 2( 3( 4( 5(

17. To what extent was the contractor effective in interfacing with the Government staff?

1( 2( 3( 4( 5(

18. What was your level of overall customer satisfaction?

1( 2( 3( 4( 5(

19. To what extent were the contractor’s employees experienced and qualified?

1( 2( 3( 4( 5( Please Respond with Yes or No on the below questions:

20. Were there any cure notices issued? (Example: If the contractor is slacking or not performing, a notice to the contractor is sent out informing them they have a certain amount of time to correct the issue.)

Yes: ____ No: ____

21. Was contractor pro-active?

Yes: ____ No: ____

22. Did contractor suggest cost-saving changes?

Yes: ____ No: ___

23. Would you recommend this contractor?

Yes: ____ No: ____

If No, please provide reason in Comments.

For Federal contracts:

24. Were there any Labor Department Investigations?

Yes:____ No: ____

a. If yes, please describe reason and final outcome.

25. Were there any safety investigations?

Yes: ___ No: ____

a. If yes, please describe reason and final outcome.

26. Were there any security investigations?

Yes: ____ No: ____

a. If yes, please describe reason and final outcome.

27. Was there a partial or complete termination for default or convenience?

Yes: ____ No: ____

a. If yes, please describe reason and final outcome.

28. Are there any pending terminations?

Yes: ____ No: ____

29. What is/was the duration of the contract? ___________

30. Were there any performance issues regarding the contractor’s work? If yes, please describe.

Comments: (Comments required for any rating of 4 or less)

Signature: ______________________________

Date: _____________________