Amendment 00002 Section J-10 Past_Performance_Questionnaire.doc

DTFAWA-17-R-00018

Amendment 0002

ATTACHMENT J-10

PAST PERFORMANCE QUESTIONNAIRE

I. Your Company Information (to be completed by Offeror) Name: ________________________________________________ Address ________________________________________________ City/State/Zip ________________________________________________ II. Size and Scope (to be completed by Offeror)

A. The Contract for this past performance is experience of maintenance and replacement services for physical security systems and related equipment or similar services over the past five (5) years (as of the release date of the SIR).

Yes No B. The Contract for this past performance is a project dealing with the same or similar size, scope and complexity as this acquisition (maintenance and replacement services for physical security and related equipment for approximately 500 facilities located throughout the CONUS and non-CONUS states and territories). Yes No

III. Customer Company Information (to be completed by customer) Client Name ________________________________________________

Address ________________________________________________ City/State/Zip ________________________________________________ Point of Contact: ________________________________________________ Telephone No: ________________________________________________ Description of Work :

Contract Term & Value: ________________________________________________ IV. Past Performance Business Practice (to be completed by customer) With regard to the above referenced contract, please select one rating, which best describes the Contractor’s ability.

1. Quality: Complies with contract requirement, technical excellence and appropriateness of delivered services and Innovative approaches and solutions to accomplish assigned task/service

_____Excellent _____ Satisfactory _____ Marginal _____ Failure

Additional Comments: __________________________________________________

2. Timeliness: Reliability, Meeting delivery schedule/milestones and Ability to identify, analyze, and establish course of successful corrective action in the case of negative schedule variances _____Excellent _____ Satisfactory _____ Marginal _____ Failure

Additional Comments: __________________________________________________

3. Program Management: Effectively achieved results of project(s) and Effectively communicated, reasonable/cooperative, and efficient

_____Excellent _____ Satisfactory _____ Marginal _____ Failure

Additional Comments: ___________________________________________________

4. Cost Control: Within budget and cost efficiencies

_____Excellent _____ Satisfactory _____ Marginal _____ Failure

Additional Comments: ___________________________________________________

5. Customer Satisfaction and Administration: Satisfactory of end users contractor requirements, promptness of contractor notification as to problems and whether the contractor was reasonable, cooperative & flexible _____Excellent _____ Satisfactory _____ Marginal _____ Failure

Additional Comments: ___________________________________________________

6. Would you recommend award to this contractor?

_______Yes ______No ________Yes, with reservation If yes with reservation, please summarize your reservations.

Print Name Signature Date

THIS FORM IS TO BE COMPLETED BY THE CUSTOMER REFERENCE AND EMAILED DIRECTLY BY THE CUSTOMER TO: Amy.Wright@faa.gov