Att_6_Past_Performance.doc

FA4803-14-R-0001

A. GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ____________________ Address: __________________________

Telephone Number: ____________________ __________________________

Fax Number: ____________________ __________________________

Point of Contact: ____________________

Project Title or Brief Description of Work: ________________________________________ Contract Number Provided by Offeror: ________________________________________

Dollar Amount: $ ________*

Contract Period or Dates of Performance Provided by Offeror: __________________________*

*Note: If offeror holds or has held other contracts with your agency/organization in the last 5 years, please complete separate evaluation forms for those contracts as well.

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name of Respondent: _____________________ Title: ____________________________

Address: _____________________ Telephone Number: ___________________

_____________________________ Fax Number: _____________________

_____________________________ Email Address: _____________________

C. FAX COMPLETED SURVEY FORM TO: ____________________________________

D. PERFORMANCE INFORMATION: Choose the number on the scale of 1 to 5 that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF 1 OR 2.

CONFIDENCE

SATISFACTORY

CONFIDENCE

SUBSTANTIAL

CONFIDENCE

UNKNOWN

CONFIDENCE

Based on the offeror’s performance record, the government has no expectation that the offeror will be able to successfully perform the required effort.

Based on the offeror’s performance record, the government has a low expectation that the offeror will successfully perform the required effort Based on the offeror’s performance record, the government has an expectation that the offeror will successfully perform the required effort.

Based on the offeror’s performance record, the government has a high expectation that the offeror will successfully perform the required effort.

No performance record is identifiable.

Commensurate with contract requirements.

Remarks:______________________________________________________________________

ATTACHMENT 6

CONTRACTOR’S NAME: ____________________ CONTRACT NUMBER______________