Attachment S-3 Past Performance Questionnaire Rev1.doc

Attachment S-3

693KA9-21-R-00016

PAST PERFORMANCE QUESTIONNAIRE

693KA9-21-R-00016

Facilities Maintenance Services

Warrenton, VA Completed by:

Title:

Agency/Company: _________________________ Phone:

Email:

The company who provided this questionnaire is proposing on a Federal Aviation Administration (FAA) acquisition of Facility Management Services. Past performance is of considerable importance to this acquisition. Therefore, input from current or previous customers of the offeror is very important.

We would greatly appreciate you taking the time to complete this form. Please provide an honest assessment and immediately return to the FAA not later than October 4, 2021, by e-mail to curtis.fields@faa.gov, the subject line of the email must be in the format “Reference Name – 693KA9-21-R-00021 Past Performance Survey” (“Reference Name” is the name of the person completing this survey .

1. Contractor Name:

2. Contract Number:

____Cost Reimbursement

Other (Please Specify):

7. Period of Performance:

8. Dollar Amount of Award: $

Total Dollar Value with Mods: $

9. Title of Contract:

10. Description of Contract:

11. Type of Work:

Construction__ Service Support__ Service__ Supply__ Other___________________

Rating

Performance Level

OUTSTANDING: Performance meets contractual requirements and exceeds many requirements to the benefit of the Government/Customer. The contractual performance of the factors being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

GOOD: Performance meets contractual requirements and exceeds some requirements to the benefit of the Government/Customer. The contractual performance of the factors being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

SATISFACTORY: Performance meets contractual requirements. The contractual performance of the factors contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

MARGINAL: Performance does not meet some contractual requirements. The contractual performance of the factors being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

UNSATISFACTORY: Performance does not meet most contractual requirements and corrections are not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

If Not Applicable, just write in N/A

NOTE: 1-Unsatisfactory 2- Marginal 3-Satisfactory 4-Good 5-Outstanding

General Questions:

Contractor’s response to technical direction, change orders, etc.?

1( 2( 3( 4( 5(

1) Reliability of contractor follow through on commitments?

1( 2( 3( 4( 5(

2) Contractor’s responsiveness to information requests, issues, or problems? 1( 2( 3( 4( 5(

3) Contractor’s professional administration and management of the contract? 1( 2( 3( 4( 5(

4) Contractor’s adherence to the Statement of Work?

1( 2( 3( 4( 5(

5) Experience and reliability of contractor’s management and support staff? 1( 2( 3( 4( 5(

6) Contractor’s tracking/response/reporting/follow-up on service requests?

1( 2( 3( 4( 5(

7) Contractor’s compliance with safety requirements in the SOW?

1( 2( 3( 4( 5(

8) Level of satisfaction with the contractor’s overall quality of service? 1( 2( 3( 4( 5(

9) Contractor’s effectiveness interfacing with the Government staff?

1( 2( 3( 4( 5( Respond: Yes or No Were there any cure notices issued?

Yes: ____ No: ____

Was contractor pro-active?

Did contractor suggest cost-saving changes?

Would you recommend this contractor?

For Federal Contracts:

Were there any Labor Department Investigations?

Were there any safety investigations?

Were there any security investigations?

Was there a partial or complete termination for default or convenience?

Are there any pending terminations?

Were there any performance issues?

*If any of the above questions are answered with a “yes”, please explain in the space provided below. If you need additional space, please use a separate sheet of paper and return with this survey* Signature: ____________________________

Date: ____________________________