Attachment 3 - Past Performance Questionnaire-Customer Satisfaction Survey.pdf
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- Solicitation number
- 697DCK-26-R-00186
About this file
This is a Performance Questionnaire template used by the Federal Aviation Administration (FAA) to collect feedback on contractor performance for source selection purposes. The form is completed in two parts: the offeror section requires contractors to provide basic contract information including contractor name and address, contract number, initiation and completion dates, total contract value, contract type (Fixed Price, GMP, FPI, etc.), and a description of contract requirements.
The evaluating organization representative section requires the evaluator to provide their name, position (Project Manager, COR, or other), organization, phone number, and the number of months the contractor's performance was monitored. The evaluator then rates the contractor across seven performance categories using a standardized scale: EX (Exceptional), VG (Very Good), S (Satisfactory), MG (Marginal), US (Unsatisfactory), and N/O (Not Observed). The evaluation criteria assess Quality of Products and Services, Performance, Technical Requirements, Schedule adherence, Cost Control, Customer Satisfaction, and Overall Assessment. The questionnaire includes a comments section for the evaluator to provide narrative feedback supporting the ratings. Completed questionnaires should be emailed to the Contracting Specialist, Richard L. Palsgrove, at Richard.L.Palsgrove@faa.gov.
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PERFORMANCE QUESTIONNAIRE
Your assistance is requested in support of a source selection
Please complete this Questionnaire and email the Contracting Specialist at:
Richard.L.Palsgrove@faa.gov
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. DESCRIPTION OF CONTRACT REQUIREMENTS:
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
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