Attach 3 - Past Performance Survey.doc

6973GH-20-R-00097

Attachment 03

PROCUREMENT SENSITIVE WHEN COMPLETED

FOR OFFICIAL USE ONLY

SIR/RFO No. 6973GH-21-R-00097 Supplemental Type Certificate (STC) Development/Certification And Associated Project Management

PAST PERFORMANCE SURVEY

To: _______________________________________________________________________

Organization:_____________________________________________________________

Fax No.: _________________________ E-mail Address: _________________________

Date: __________________________ Number of Pages (including this sheet): 5 in total Your name was provided as a past performance point of contract for the following:

Contractor Name:_________________________________________________________

Contract Number: _______________________________ Date(s) ____________________

Project Title: ___________________________________________________________

Contractor Role / Responsibility (circle one): Prime Contractor Sub-Contractor

In regard to the above contractor’s performance on the referenced contract, please complete the attached Past Performance Questionnaire and return as follows:

Send to: KATHLEEN ISLAS, Contracting Officer E-mail Address: kathleen.d.islas@faa.gov For questions, please contact me at telephone 405-954-8534 Please provide your response no later than Tuesday, May 18, 2021 Thank you!

A. Please complete and/or verify the following reference check information:

1. Name of Contractor: ____________________________________________________

2. Type of contract/agreement for pricing; e.g., firm fixed-price, fixed rate per hour (labor-hour, T&M), cost-reimbursable:

3. Contract Number: _________________________________

4. Total Contract Amount: $____________________________

5. Date of Contract Award: ____________________________

6. Contract Period of Performance: Start _________________ Complete_____________

B. Please complete and/or verify the following responder information:

Name of Responding Point of Contact: _____________________________________________________

Agency/Organization:

Mailing Address:

Telephone Number:

E-mail Address:

1.

How would you rate the contractor's overall compliance with contract requirements?

( ) Acceptable

( ) Unacceptable

2.

How would you rate the timeliness of the Contractor - adhering to the required schedule?

3.

Has this contract been partially or completely terminated for default, or is a termination pending?

( ) Yes / If yes, please explain and indicate the status.

( ) No/Acceptable

4.

Has it ever been necessary to send this Contractor a Notice to Cure letter?

( ) Yes If yes, please explain and indicate the status.

( ) No/Acceptable

5.

How would you rate the performance of the contractor's Project or Program Management?

6.

Would you recommend awarding similar contracts or using the offeror again for future work?

( ) Yes/Acceptable ( ) No/Unacceptable 7.

Did you experience any integrity problems with this Contractor?

( ) Yes If yes, please explain.

( ) No/Acceptable

8.

Please provide any other comments you may have.

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