Attachment 9- Past Performance Survey.docx

PROCUREMENT SENSITIVE WHEN COMPLETED

FOR OFFICIAL USE ONLY

SIR/RFO No. 6973GH-22-R-00063

MMAC PV SYSTEM QUESADA DRIVE WEST

PAST PERFORMANCE SURVEY

To: _______________________________________________________________________ NAME Title

Organization:_____________________________________________________________

Fax No.: _________________________ E-mail Address:_________________________

Phone No.:________________________

Date: __________________________ Number of Pages (including this sheet): 5 in total

Your name was provided as a point of contact for the following:

Contractor Name:_______________________________________________________

Contract Number: _______________________________

Project Title: ___________________________________________________________

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

Send to: Elizabeth Fikes, Contracting Officer

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

For questions, please contact me at telephone 405-954-7869.

Please provide your response no later than March XX, 2022 3:00 p.m. CT

Thank you!

Offeror to complete this page:

1. Name of Contractor: ____________________________________________________

2. Provide a brief description of the renovation project and how it is relevant to the HQB Building Lobby Remodel; e.g., multi-story office, single story office building, hospital, school, warehouse, square footage?

3. Type of contract; e.g., firm fixed-price, cost-reimbursable: __________________________________________

4. Contractor Role (circle one):

Prime Contractor, Mechanical Subcontractor, Electrical Subcontractor, Pool Subcontractor

5. Contract Number (if applicable): _______________________________________________

6. Total Contract Amount - Original contract amount: $____________ Final Contract Amount: $_____________ Provide rationale for the difference________________________________________________________

7. Date of Contract Award: ______________________________________________________

8. Contract Period of Performance: Start Complete _________________

9. Was project completion date consistent with the contract completion date? ___________ If no, explain why___________________________________________________________________________________.

10. Was a deficiency notice issued? ___________ If so, was the issue successfully resolved? ___________

11. Was a Cure Notice issued? _____________ If so, was the issue successfully resolved? _____________

12. Was a Show Cause issued? _____________ If so, was the issue successfully resolved? _____________

Name of Responding Point of Contact: _____________________________________________________

Agency/Organization: _________________________________________________________________

Mailing Address: __________________________________________________________

Telephone Number: __________________________________

E-mail Address: __________________________________ Customer to complete the following pages:

A five level assessment rating system will be used for the following questions as defined below:

1. Quality of Project.

a. How would you rate the quality of the project?

NOTE: If you provide a rating above or below “Satisfactory” you will need to document your rationale for the use of your rating.

2. Scheduling of Project.

a. How would you rate the scheduling of the project?

NOTE: If you provide a rating above or below “Satisfactory” you will need to document your rationale for the use of your rating.

3. Cost Control of Project Modifications.

a. How would you rate the contractor’s cost control of project modifications?

NOTE: If you provide a rating above or below “Satisfactory” you will need to document your rationale for the use of your rating.

4. Management of Subcontractors. (Only answer this question if the contractor being evaluated is the general contractor and not a subcontractor)

a. How would you rate the subcontract management demonstrated by the general contractor

NOTE: If you provide a rating above or below “Satisfactory” you will need to document your rationale for the use of your rating.

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

6. Please provide any other comments you may have.

Attachment 9