Past Performance Questionnaire/Survey-MSWord.doc

697DCK-18-R-00032

Attachment

PAST PERFORMANCE SURVEY

Replacement of four (4) Communication Towers at Woodstock, CT

Individual Completing Survey:

_________________________ (Name)

_________________________ (Agency/Company)

The Federal Aviation Administration is currently evaluating ____________________________ and you were listed you as a performance reference. It would be greatly appreciated if you would take 5 or 10 minutes to complete the following information and scan/email within three (3) days of receipt to my attention at: Send/Email (Adobe .pdf) at Michael.Eadon@faa.gov.

If you have any questions or comments, feel free to contact me. Thank you in advance for your assistance.

Michael J. Eadon, Contract Specialist Federal Aviation Administration

Eastern Acquisition, Southern Region AAQ-560 College Park, GA 30337

Tel: 404-305-5981 Email: Michael.Eadon@faa.gov

1. Contractor Name:

2. Contract Number:

____Cost Reimbursement

___ Other (Please Specify)

7. Period of Performance:

8. Dollar Amount of Award: $

Total Dollar Value with Mods:

9. Title of Contract:

10. Description of Contract Requirement:

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 below 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.?

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

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

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

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

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

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

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

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

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

12. What was your level of overall customer satisfaction?

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

Respond: Yes or No.

Were there any cure notices issued?

Yes: ____ No: ____

Was contractor pro-active?

Yes: ____ No: ____

Did contractor suggest cost-saving changes?

Yes: ____ No: ____

Would you recommend this contractor?

Yes: ____ No: ____

For Federal contracts:

Were there any Labor Department Investigations?

Yes: ____ No: ____

If yes, please describe reason and final outcome.

Were there any safety investigations?

Were there any security investigations?

Are there any pending terminations?

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

Please provide other comments:

Signature: ____________________________ Date: ____________________________

(c:\030000 PHX\Past Perf Survey)