Attachment III - Past Performance Survey (Fillable).doc
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- Solicitation number
- 1131PL26R0002
About this file
This is a Past Performance Survey form used by the United States Trade and Development Agency (USTDA) to collect feedback on contractor performance for the Regional Africa Digital Infrastructure Opportunities Desk Study Series solicitation. The survey is a template designed to be completed by agencies or organizations that have previously worked with a contractor being considered for award on solicitation number 1131PL24R0002. Completed surveys must be submitted to USTDA's Office of Acquisition Management at Contractproposals@ustda.gov no later than 1:00 PM on March 16, 2026 (Arlington, VA time).
The survey requests information about the contractor being reviewed, including contract number, agency submitting the review, period of performance, description of services, and total contract value. Evaluators are asked to rate their confidence in the contractor across five key performance areas: ability to comply with contract terms and conditions, ability to complete work on schedule, ability to comply with actual requirements, ability to take corrective measures, and likelihood of recommending the contractor for future business. All ratings use a five-point scale ranging from Substantial Confidence to No Confidence, with space for written comments and explanations. The form also provides space for additional performance observations or concerns not addressed in the structured questions.
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Text version
SOLICITION NUMBER: 1131PL24R0002
TITLE: REGIONAL AFRICA – DIGITAL INFRASTRUCTURE OPPORTUNITIES DESK STUDY SERIES
PAST PERFORMANCE SURVEY
Please Submit Completed Survey to USTDA’s Office of Acquisition Management at Contractproposals@ustda.gov, no later than 1:00 PM, March 16, 2026, 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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