Attachment 11. = Past Performance Survey Form 5-20-2025.doc
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- Solicitation number
- 6973GH-25-R-00167
About this file
The document is a Past Performance Survey form used by the Federal Aviation Administration (FAA) for evaluating contractors applying to a Qualified Vendors List (QVL) for construction services. The survey is designed to comprehensively assess a contractor's performance across 19 rating categories, ranging from resource commitment and problem-solving to management effectiveness, quality of service, and adherence to safety requirements. Contractors are rated on a scale of 1-5 for each performance metric, with additional sections inquiring about cure notices, proactive behavior, cost-saving suggestions, and potential investigations or terminations.
The associated federal contract opportunity (Solicitation Number 6973GH-25-R-00167) involves establishing a QVL for construction services related to AJW-242 Unstaffed Infrastructure Sustainment (UIS) facilities located on and off Airport Operating Areas across various US locations. The FAA is seeking qualified contractors to perform construction services, with an update on 7-30-2025 indicating amendment revisions and additional attachment uploads including technical documents about installation, communications facilities, and spectrum management regulations. Contractors can obtain more information by contacting the contracting officer, Janice Hammonds, via email or phone, and approved contractors will be listed in a spreadsheet on SAM.GOV.
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Text version
PAST PERFORMANCE SURVEY
What QVL Construction Category does this survey apply to?
1. Contractor Name:
2. Contract /Task Order(TO) /Purchase
Order (PO) Number:
3. Contractor Address:
4. Contract Type:
___ Firm Fixed Price
___ Cost Reimbursement
___ Other (Please Specify)
5. Contract Agency Name:
Example: FAA, US Air Force etc.
6. Project Owner or Project Manager for the contractor: name/phone/email:
Example: COR, Project Manager
7. Contract Completion Date:
8. Dollar Amount of Contract Award:
Total Dollar Value with Mods:
9. Title of Contract and Location of project:
10. Project Description-- to include the role of the contractor on the project and specific responsibilities of the contractor in performance of the effort for the QVL construction category the applicant is applying for:
10a. Did your company serve as the prime contractor or sub-contractor on this project?
11. Type of Work:
Construction Service Support Service Supply Other
NOTE: 1-Unsatisfactory 2- Marginal 3-Satisfactory 4-Good 5-Outstanding If Not Applicable, just write in N/A
Please provide additional comments at the bottom of the page for ratings of 3 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?
1( 2( 3( 4( 5(
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?
1( 2( 3( 4( 5(
6. How effective has the contractor been in identifying user requirements?
1( 2( 3( 4( 5(
7. To what extent did the contractor have the ability to administer and manage the contract?
1( 2( 3( 4( 5(
8. To what extent did the contractor issue professional correspondence?
1( 2( 3( 4( 5(
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?
1( 2( 3( 4( 5(
15. To what extent did the contractor comply with safety requirements?
1( 2( 3( 4( 5(
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( Respond: Yes or No.
20. Were there any cure notices issued?
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?
Yes: ____ No: ____
a. If yes, please describe.
Do you have any comments to add: (Comments required for any rating of 3 or less)
Digital Signature or pen and ink signature (please do not type): __________________
Date: ______________________
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