Attachment V - Past Performance Survey (Fillable).doc
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- Solicitation number
- 1131PL23RDS31204
About this file
This document contains a past performance survey template for federal contractors. The survey collects feedback on a contractor's performance on an unspecified prior contract to provide desk studies for smart grid opportunities in regional South and Southeast Asia. The United States Trade and Development Agency issued the solicitation and is collecting the surveys, due by September 1, 2023, to evaluate contractors' past performance. The survey questions rate the contractor's ability to comply with contract terms, complete work on schedule, meet requirements, and take corrective actions. It also asks if the agency would recommend and do future business with the contractor. Additional comments on the contractor's performance can be provided.
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Text version
SOLICITION NUMBER: 1131PL23RDS31204
TITLE: REGIONAL SOUTH AND SOUTHEAST ASIA: DESK STUDY FOR SMART GRID
OPPORTUNITIES
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 1, 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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