Past Performance Survey Attachment 1.doc

FA7012-09-T-0017

PAST PERFORMANCE SURVEY

RESPONDENT’S TITLE:

RESPONDENT’S NAME:

PHONE #:

CONTRACTOR’S NAME:

CONTRACT #:

CONTRACT TITLE:

LOCATION OF WORK:

DOLLAR VALUE OF CONTRACT: ANNUAL: $

TOTAL VALUE: $

1. Please describe the type of contract (firm-fixed price, cost plus, indefinite quantity, incentive/award fee, combination, etc).

Remarks:

2. What was the general scope (functional requirements) and contract term of the contract?

Remarks:

3. Please identify which year of the contract the contractor is currently performing. Or, if the contract is complete what years did the contractor provide the services.

Remarks:

4. SPECIFIC AREAS OF PERFORMANCE RATINGS:

E EXCEPTIONAL/HIGH CONFIDENCE - Performance meets contractual requirements and exceeds many (requirements) to the Government's benefit. The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V VERY GOOD/SIGNIFICANT CONFIDENCE - Performance meets contractual requirements and exceeds some (requirements) to the Government's benefit. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY/CONFIDENCE - Performance meets contractual requirements. The contractual performance of the element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL/LITTLE CONFIDENCE - Performance does not meet some contractual requirements. The contractual performance of the element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor's proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY/NO CONFIDENCE - Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element being assessed contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

N NOT APPLICABLE/UNKNOWN CONFIDENCE - Unable to provide a score. Performance in this area not applicable to effort assessed.

a. Were you satisfied with the quality of services received? Yes/No

b. How was the quality of work received?

E

V

S

M

U

N

Remarks:

c. Completed work as per the approved contract performance schedule specified in the contract.

E

V

S

M

U

N

Remarks:

d. Performed work with minimal disruption to the customer and kept communications opened with all parties.

S

M

U

N

Remarks:

e. Submit Base Welcome Guide, Phonebook, and Map according to schedule in a timely manner.

S

M

U

N

Remarks:

f. Would you have any reservations in awarding another contract to the offeror? Yes/No

E

V

S

M

U

N

Remarks:

g. Select one rating which most accurately describes the contractors’ overall performance on your contract

E

V

S

M

U

N

Remarks:

Attachment 1