Attachment III - Past Performance Survey (Fillable) .doc

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Attached to
REGIONAL INDO-PACIFIC: INDO-PACIFIC AVIATION DEFINITIONAL MISSION
Solicitation number
1131PL23RDM31010
Issued by

About this file

This document includes a past performance survey template and details of a related federal contract opportunity solicitation. The solicitation is for regional aviation definitional mission services in the Indo-Pacific region. It is a 100% small business set-aside with a size standard of $16.5M annual sales. Offerors must be registered in SAM with an active status. Proposals are due by December 20th, 2022. The contract will be awarded based on best value. International transportation and insurance must have a U.S. source and origin. Local services in host countries are not restricted. Only U.S. firms and individuals employing U.S. citizens or lawful permanent residents can be awarded the contract.

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Solicitation: REGIONAL ASIA FOR 2022 - 2023 INDO-PACIFIC AVIATION DEFINITIONAL MISSION (DM) Solicitation No.: 1131PL23RDM31010

PAST PERFORMANCE SURVEY

Please Submit Completed Survey to USTDA’s Office of Acquisition Management at Contractproposals@ustda.gov, no later than 1:00 PM, December 20, 2022, Arlington, VA Time.

Name of Contractor Being Reviewed:

Contract Number/Reference Information:

Name of Agency/Organization Submitting Review for this Contractor:

Name of Person Completing Questionnaire
Phone Number
Email Address
Period of Performance: XX/XX/XXXX – XX/XX/XXXX
Brief Description of Services: XXXXXXXXX

Total Contract Value: $XXXX.XX

Contract Performance Information

Questions:
Response:
1. How would you rate your confidence in the contractor’s ability to comply with contract terms and conditions?
· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

· Unknown/Neutral Confidence

· No Confidence

2. How would you rate your confidence in the contractor’s ability to complete work on schedule?
· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

· Unknown/Neutral Confidence

· No Confidence

3. How would you rate your confidence in the contractor’s ability to comply with the actual requirements?
· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

· Unknown/Neutral Confidence

· No Confidence

4. How would you rate your confidence in the contractor’s ability to take appropriate corrective measures to prevent problems and/or problem reoccurrence?
· Substantial Confidence

· Satisfactory Confidence

· Limited Confidence

· Unknown/Neutral Confidence

· No Confidence

5. Would you recommend and/or do business with this contractor in the future? If your answer is No, please explain why.

· Yes

· No

Comment:

6. Were there any issues not discussed above or do you have any additional comments on the contractor’s performance that you would like to discuss?
· Yes

· No Comment:

USTDA sincerely thanks you for taking the time to complete this questionnaire and for your contribution to the success of our acquisition program.

Additional Comments:

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