Attachment V - Past Performance Survey (Fillable).doc
DOC document 44 KB Posted
- Solicitation number
- 1131PL24RDM51042
About this file
This document contains a past performance survey template for evaluation of contractors. The survey requests feedback on a contractor's performance on an unspecified prior contract to provide services related to a Regional Latin America and the Caribbean Definitional Mission for Digital Infrastructure Sector Opportunities. The United States Trade and Development Agency solicitation number is 1131PL24RDM51042. The survey poses six questions gauging confidence in the contractor's ability to comply with contract terms, complete work on schedule, comply with requirements, take corrective actions, and a recommendation for future business. Respondents are asked to provide contact information and details of the prior contract. Feedback must be submitted to USTDA's Office of Acquisition Management by December 21, 2023.
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Solicitation Regional Latin America and the Caribbean: Definitional Mission for Digital Infrastructure Sector Opportunities Solicitation No.: 1131PL24RDM51042
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 21, 2023, 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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