Past Performance Survey.doc
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- Solicitation number
- 2026FSDO
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This is a Past Performance Survey form used by the Federal Aviation Administration to evaluate contractor performance on previous contracts relevant to the South Florida Flight Standards District Office (FSDO) Furniture Replacement procurement (SIR/RFO No. 6973GH-26-R-00181). The survey requests references to complete a questionnaire regarding a specific contractor's performance on a prior contract, with responses due by August 17, 2026, at 2:00 p.m. CST, directed to Contracting Officer Shomari Wilson at shomari.y.wilson@faa.gov or 405-954-5069.
The survey form collects reference information including the contractor name, contract type (firm fixed-price, labor-hour, cost-reimbursable, etc.), contract number, total contract amount, award date, and performance period. The responding point of contact must provide their agency or organization information and mailing address. The evaluation criteria assess contractor compliance with contract requirements, schedule adherence, termination history, cure notice issuance, key personnel performance, recommendation for future work, and any integrity issues. This template does not specify particular products or services required but instead serves as a due diligence instrument for evaluating potential contractors' past performance qualifications for the larger FSDO relocation and furniture procurement project involving design, procurement, delivery, and installation of integrated Haworth furniture solutions for a 53,174 square foot facility accommodating 318 personnel.
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Text version
PROCUREMENT SENSITIVE WHEN COMPLETED
FOR OFFICIAL USE ONLY
SIR/RFO No. 6973GH-26-R-00181 South Florida Flight Standards District Office Furniture Replacement
PAST PERFORMANCE SURVEY
To: _______________________________________________________________________
Organization:_____________________________________________________________
Fax No.: _________________________ E-mail Address:_________________________
Date: __________________________ Number of Pages (including this sheet): 4 in total Your name was provided as a past performance point of contract for the following:
Contractor Name:_________________________________________________________
Contract Number: _______________________________ Date(s)____________________
Project Title: ___________________________________________________________
Contractor Role / Responsibility (circle one): Prime Contractor Sub-Contractor
In regard to the above contractor’s performance on the referenced contract, please complete the attached Past Performance Questionnaire and return as follows:
Send to: Shomari Wilson, Contracting Officer E-mail Address: shomari.y.wilson@faa.gov For questions, please contact me at telephone 405-954-5069 Please provide your response no later than August 17, 2026, 2:00 p.m. CST.
Thank you!
A. Please complete and/or verify the following reference check information:
1. Name of Contractor: ____________________________________________________
2. Type of contract/agreement for pricing; e.g., firm fixed-price, fixed rate per hour (labor-hour, T&M), cost-reimbursable:
3. Contract Number: _________________________________
4. Total Contract Amount: $____________________________
5. Date of Contract Award: ____________________________
6. Contract Period of Performance: Start _________________ Complete_____________
B. Please complete and/or verify the following responder information:
Name of Responding Point of Contact: _____________________________________________________
Agency/Organization: _________________________________________________________________
Mailing Address:
Telephone Number:
E-mail Address:
1.
How would you rate the contractor's overall compliance with contract requirements?
( ) Acceptable
( ) Unacceptable
2.
How would you rate the timeliness of the Contractor - adhering to the required schedule?
3.
Has this contract been partially or completely terminated for default, or is a termination pending?
( ) Yes / If yes, please explain and indicate the status.
( ) No/Acceptable
4.
Has it ever been necessary to send this Contractor a Notice to Cure letter?
( ) Yes If yes, please explain and indicate the status.
( ) No
5.
How would you rate the performance of the contractor's key personnel?
6.
Would you recommend awarding similar contracts or using the offeror again for future work?
( ) Yes/Acceptable ( ) No/Unacceptable 7.
Did you experience any integrity problems with this Contractor?
( ) Yes If yes, please explain.
( ) No
8.
Please provide any other comments you may have.
Attachment 4
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