Attachment 04 - Past Performance Questionnaire.pdf

PERFORMANCE QUESTIONNAIRE

Your assistance is requested in support of a source selection Please complete this Questionnaire and email or send by facsimile to Elisha Distler, Federal Aviation Administration Contracting Officer at:

Elisha.Distler@faa.gov Refurbish MFE ATCT Please ensure this form is completed, signed and return to the Contracting Officer.

TO BE COMPLETED BY OFFEROR

1. CONTRACTOR NAME & ADDRESS: 2. CONTRACT NO:

3. CONTRACT INITIATION DATE:

4. COMPLETION DATE:

5. TOTAL CONTRACT VALUE:

6. TYPE OF CONTRACT:

(Fixed Price, GMP, FPI, etc.)

7. DETAILED DESCRIPTION OF PROJECT

TO BE COMPLETED BY EVALUATING ORGANIZATION REPRESENTATIVE

8. EVALUATION: a. EVALUATOR'S NAME, POSITION (Project Manager/ COR/ Other) AND ORGANIZATION:

b. EVALUATOR'S PHONE NUMBER: c. MONTHS PERFORMANCE MONITORED BY EVALUATOR:

Please circle the response code for each topic (A – G) that best reflects your experience with this contractor.

EX = Exceptional S = Satisfactory US = Unsatisfactory VG = Very Good MG = Marginal N/O = Not Observed A. Quality of Products and Services - Assess the contractor’s conformance to contract requirements, specifications, and standards of good workmanship (e.g., technical, professional, environmental, or safety and health standards).

EX VG S MG US N/O

B. Performance – Assess the contractor’s performance as the General Contractor or Architect/Engineer (as appropriate) for the project.

EX VG S MG US N/O

C. Technical Requirements – Assess the contractor’s ability to fulfill the technical requirements of the contract.

EX VG S MG US N/O

D. Schedule – Assess the timeliness of contractor against the schedule of activities.

EX VG S MG US N/O

E. Cost Control – Assess the contractor’s ability to manage the contract budget and control costs.

EX VG S MG US N/O

F. Customer Satisfaction – Assess the contractor’s responsiveness to customer concerns and “user friendliness”

EX VG S MG US N/O

G. Overall Assessment.

EX VG S MG US N/O

Comments: One additional page can be added for comments, if applicable.

mailto:Robert.Higgins@faa.gov