Attachment 4 - Past Performance Questionnaire.pdf

6973GH-21-R-00029

Attachment 4

PROCUREMENT SENSITIVE WHEN COMPLETED

FOR OFFICIAL USE ONLY

SIR/RFO No. 6973GH-21-R-00029

A&E SERVICES

PAST PERFORMANCE QUESTIONNAIRE

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: Elizabeth Fikes, Contracting Officer

E-mail Address: Elizabeth.A.Fikes@faa.gov

For questions, please email the above.

Please provide your response no later than APRIL 13, 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: __________________________________

Rating Narrative

4 Excellent 3 Good 2 Satisfactory 1 Marginal 0 Unacceptable

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

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.

5. How would you rate the performance of the contractor's key personnel?

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

( ) Yes ( ) No

0 1 2 3 4

0 1 2 3 4

0 1 2 3 4

7. Did you experience any integrity problems with this Contractor?

( ) Yes If yes, please explain.

8. Please provide any other comments you may have.