Attachment 3 - STC Past Performance Survey.doc

HTC711-09-R-0040

ATTACHMENT 3

PAST PERFORMANCE SURVEY

When Filled In This Document Is Source Selection Sensitive

Information IAW FAR 2.101 & 3.104

A. GENERAL INFORMATION: (To be completed by Offeror) Contractor’s Name: _____________________________________________________________________________ Address:______________________________________________________________________________________ Telephone Number: _____________________________________________________________________________ Email: _______________________________________________________________________________________ Point of Contact: ______________________________________________________________________________ Project Title and Brief but Detailed Description of Work (including workload estimates):

Contract Number :

Contract Value (Base & Option Years): $

Place of Performance: ________________________________________________ Period of Performance: ________________________________________________ Contractor Performed as the ( Prime Contractor ( Sub-Contractor.

B. RESPONDENT INFORMATION (To be completed by Respondent):

Name of Respondent: ____________________________________________Title:_______________________________

Address: _____________________________________________________________________________________ Telephone Number:

Fax Number:___________________________ Email Address:

Note: If any of the information in Section A is incorrect, please make necessary changes. Also, if offeror holds or has held other relevant contracts with your agency/organization in the last 3 years, please complete separate evaluation forms for those contracts as well.

C. FAX OR E-MAIL COMPLETED SURVEY FORM TO:

Please fax/email the completed survey to the below address no later than: 22 July 2009 /4:00 PM CST to:

USTRANSCOM/TCAQ-R

ATTN: Mr Belfield Collymore or Ms Teresa Perry

Fax: 618-256-6419

Phone: 618-256-6626 or 618-256-6628 Email: belfield.collymore@ustranscom.mil Email: teresa.perry@ustranscom.mil Direct survey completion questions/comments to the above address/individual(s)

NOTE: PPIRS may be reviewed. Although you may have filed a Contractor Performance Assessment Report (CPARS) for the contract listed, we would appreciate your response to this survey because some of the questions relate to areas not covered by CPARS.

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.

THE CONTRACTOR:

GENERAL:

REMARKS

PLEASE PROVIDE A PARAGRAPH SUPPORTING YOUR ABOVE RATINGS. EXPLAIN THE CONTRACTOR’S GREATEST STRENGTHS AND/OR WEAKNESSES AND YOUR RATIONALE FOR WHY YOU WOULD OR WOULD NOT AWARD A FUTURE CONTRACT TO THEM.

Survey Respondent’s Signature

Date

Thank you for your prompt response and assistance!