Attachment 4 - Past Performance Survey.pdf

PROCUREMENT SENSITIVE WHEN COMPLETED

FOR OFFICIAL USE ONLY

SIR/RFO No. 6973GH-22-00173

Technical Research Support Services in support of Aviation Safety

PAST PERFORMANCE SURVEY

Attachment 3

To: _______________________________________________________________________

Organization: _____________________________________________________________

Fax No.: _________________________ E-mail Address: _________________________

Date: __________________________ Number of Pages (including this sheet): 4 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: Cynthia Cooper, Contracting Officer

E-mail Address: Cynthia.Cooper@faa.gov

Please provide your response no later than 3:00 p.m. CT on July 29, 2022 .

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 performance– (e.g. adhering to milestone and delivery schedules?

3. How would you rate the performance of the Contractors Communication, Exchange of Information?

(e.g. Was it responsive, consistent, effective, affirming of a successful contract performance?)

( ) Unacceptable (If Unacceptable please provide examples and identify status or outcome)

4. Did the contractor adhere to its proposed costs/price as well as submitting billing/invoices timely, accurate and complete?

5. Did the contract require corrective action at any time during contract performance? (e.g. informal notice, stop work, formal cure notice, show cause)

( ) Yes (If yes, please explain and identify status and outcome).

( ) No

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

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

( ) No

7. How would you rate the performance of the contractor's key personnel (Program

Manager/Administrative)?

8. Would you recommend awarding similar contracts or using the offeror again for future work and can it be supported by positive performance of the requirements.

( ) Yes/Acceptable (If yes, please provide an example(s) of positive performance) ( ) No/Unacceptable (If no, please highlight examples of poor performance)

9. Please provide any other comments you may have.