Past Performance Form.doc

ATTACHMENT 4

The Federal Avia0088 BAD-RAPCON and you were listed as a performance reference. It would be appreciated if you would take 5 minutes to complete the following information and return to me via email at .

CO – Name and Contact information

1. Contractor Name:

2. Contract Number:

3. Contractor Address:

4. Contract Type: __Firm Fixed Price

____Cost Reimbursement

___ Other (Please Specify)

5. Your Agency Name:

6. Your Agency POC/Phone/email/Fax:

7. Period of Performance:

8. Dollar Amount of Award: ________ Total Dollar Value with Mods:_________

9. Title of Contract:

10. Description of Contract Service:

11. Type of Work:

Construction__ Service Support__ Service__ Supply__ Other___________________

NOTE: 1-Unsatisfactory 2- Marginal 3-Satisfactory 4-Good 5-Outstanding If Not Applicable, just write in N/A

***Please provide additional comments below for ratings of 4 and below.

1. Did the contractor commit adequate resources in timely fashion to the contract to meet the requirements and to successfully solve problems?

1( 2( 3( 4( 5( 2.

To what extent did the contractor respond positively and promptly to technical direction, contract change orders, etc.?

1( 2( 3( 4( 5( 3.

How reliably did the contractor follow through on commitments?

1( 2( 3( 4( 5( 4.

To what extent did the contractor’s management system provide visibility into problems and risks? 1( 2( 3( 4( 5( 5.

How responsive do you think the contractor was to information requests, issues, or problems during the course of the contract?

1( 2( 3( 4( 5( 6.

How effective has the contractor been in identifying user requirements?

7.

To what extent did the contractor have the ability to administer and manage the contract?

8. To what extent did the contractor issue professional correspondence?

9.

How well did the contractor adhere to the Statement of Work?

1( 2( 3( 4( 5( 10.

What was your level of satisfaction with the contractor’s management and support staff?

1( 2( 3( 4( 5( 11.

What was your level of satisfaction with the contractor’s Supervisor(s)?

1( 2( 3( 4( 5( 12.

To what extent did the contractor submit required reports and documentation in a timely manner?

1( 2( 3( 4( 5( 13.

To what extent were the contractor’s reports and documentation accurate and complete?

1( 2( 3( 4( 5( 14.

To what extent was the contractor’s maintenance and problem tracking/reporting documentation timely, accurate and of appropriate content?

1( 2( 3( 4( 5( 15.

To what extent did the contractor comply with safety requirements?

16.

What was your level of satisfaction with the contractor’s overall quality of service?

1( 2( 3( 4( 5( 17.

To what extent was the contractor effective in interfacing with the Government staff?

1( 2( 3( 4( 5( 18.

What was your level of overall customer satisfaction?

1( 2( 3( 4( 5( 19.

To what extent were the contractor’s employees experienced and qualified?

1( 2( 3( 4( 5( Respond: Yes or No.

20.

Were there any cure notices issued?

Yes: ____ No: ____

21.

Was contractor pro-active?

Yes: ____ No: ____

22.

Did contractor suggest cost-saving changes?

Yes: ____ No: ___

23.

Would you recommend this contractor?

Yes: ____ No: ____

If No, please provide reason in Comments.

For Federal contracts:

24.

Were there any Labor Department Investigations?

Yes:____ No: ____

24a.

If yes, please describe reason and final outcome.

25.

Were there any safety investigations?

Yes: ___ No: ____

25a.

If yes, please describe reason and final outcome.

26.

Were there any security investigations?

Yes: ____ No: ____

26a.

If yes, please describe reason and final outcome.

27.

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

Yes: ____ No: ____

27a.

If yes, please describe reason and final outcome.

28.

Are there any pending terminations?

Yes: ____ No: ____

29.

What is/was the duration of the contract? ___________

30.

Were there any performance issues regarding the contractor’s work? If yes, please describe.

Comments: (Comments required for any rating of 4 or less)

Signature: ______________________

Date: ____________________________