Attachment V - Past Performance Survey (Fillable).doc
DOC document 44 KB Posted
- Attached to
- REGIONAL LATIN AMERICA AND CARIBBEAN: DEFINITIONAL MISSION FOR HEALTHCARE SECTOR OPPORTUNITIES
- Solicitation number
- 1131PL23RDM51158
About this file
This document contains a past performance survey template for a contractor providing services related to a solicitation by the United States Trade and Development Agency. The survey collects feedback on a contractor's ability to comply with contract terms, complete work on schedule, meet requirements, take corrective actions, and whether the agency would recommend or do future business with the contractor. Respondents are asked to provide their level of confidence in the contractor across several performance categories and additional comments. The solicitation number is 1131PL23RDM51158 and seeks definitional mission services for identifying healthcare sector opportunities in Latin America and the Caribbean, with a response deadline of July 17, 2023.
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Text version
Solicitation Regional Latin America and Caribbean: Definitional Mission for Healthcare Sector Opportunities Solicitation No.: 1131PL23RDM51158
PAST PERFORMANCE SURVEY
Please Submit Completed Survey to USTDA’s Office of Acquisition Management at Contractproposals@ustda.gov, no later than 1:00 PM, July 17, 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:
PAGE
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