Attachment III - Past Performance Survey (Fillable) .doc
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- Solicitation number
- 1131PL21RDM21256
About this file
This document contains a solicitation for a definitional mission for clean energy and climate resilient infrastructure opportunities in the Middle East and North Africa region. The United States Trade and Development Agency is seeking offers for a firm-fixed price contract with a cost-reimbursable contract line item number for other direct costs. Offerors must be registered in the System for Award Management database and meet eligibility requirements. The solicitation is a 100 percent small business set-aside conducted according to Federal Acquisition Regulation procedures. Responses are due by September 17, 2021. The contract will support identifying clean energy and climate resilient infrastructure project opportunities across the region to be potentially supported by USTDA funding.
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Solicitation: Regional MENA - EE: Definitional Mission (DM) for Clean Energy and Climate Resilient Infrastructure Opportunities Solicitation No.: 1131PL21RDM21256
PAST PERFORMANCE SURVEY
Please Submit Completed Survey to USTDA’s Office of Acquisition Management at Contractproposals@ustda.gov, no later than 1:00 PM, September 17, 2021, 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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