1202SC23Q2710 Attachment 6 PastPerformanceQuestionnaire.pdf

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Attached to
Fire Hose Refurb- Inspecting, teasting, washing, drying, rolling and repair of Federal Government Fire Hose
Solicitation number
1202SC23Q2710
Issued by

About this file

This document contains a past performance questionnaire for a firm-fixed price services contract. The United States Department of Agriculture Forest Service is soliciting quotes to inspect, test, wash, dry, and roll federal government fire hoses in support of the Redmond Air Center Northwest Area Incident Support Cache located in Deschutes County, Oregon. The base period of performance is one year with four optional one-year extensions. Quotes are due by June 16, 2023 at 2:00pm Pacific time and the solicitation is set aside exclusively for small businesses. The associated NAICS code is 561990 with a $16.5 million size standard.

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PAST PERFORMANCE QUESTIONNAIRE (PPQ)

SECTION I: CONTRACTOR INFORMATION

A. Your Company Name and Address:

B. Phone /Fax #:

C. Point of Contact/Email Address:

D. Authorization is hereby granted to provide the information requested in SECTION II and III of this questionnaire.

Signature of Authorized Contractor Representative Date

Printed Name and Title of Authorized Contractor Representative

SECTION II: RESPONDENT INFORMATION: Request a reference from respondent by completing Section II and III and return to:

A. Client/Reference Name and Address:

B. Phone /Fax #:

C. Point of Contact/Email Address:

D. Reference Contract Number:

Project Title:

Contract Value/Type:

Period of Performance:

How long have you worked with the contractor:

More detailed description of the work performed:

Date completed:

Past Performance Evaluation Ratings

Rating Description

A = Acceptable Based on the offeror’s performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown.

U = Unacceptable Based on the offeror’s performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

SECTION III: PERFORMANCE EVALUATION

A. CONTRACT PERFORMANCE A U

1. Working relationship with your Company?

2. How well did the contractor provide experienced workers, managers and supervisors with the technical and administrative abilities needed?

3. Did the contractor exhibit knowledge of and compliance with government (or other) regulations and industry standards?

4. How well did the contractor provide and properly maintain operational equipment throughout the term of the contract?

5. Did the contractor demonstrate the ability to hire, maintain, and replace, if necessary qualified personnel during the contract?

6. How well did the contractor comply with Environmental, health, labor laws, safety and security requirements?

7. How well did the contractor coordinate and control subcontractors, if any?

8. Contractor’s Overall Performance.

B. QUALITY OF SERVICE/CONTROL A U

1. Contractor’s accomplishment in meeting the quality standards.

2. The contractor provided an effective quality control plan or inspection procedures to meet contract requirements? If no, please explain.

3. Contractor identified and corrected deficient Work.

4. Contractor’s Overall Quality of Workmanship.

C. TIMELINESS OF PERFORMANCE A U

1. How well did the contractor comply with the contract schedule?

2. Did the contractor provide timely and accurate records, submittals, and/or reports?

3. How well did the contractor resolve any delays?

REMARKS: For ratings of unacceptable, please provide remarks to describe the reasons for the rating. If additional remarks are necessary, please attach an additional sheet.

A Your Company Name and Address:
B Phone Fax:
C Point of ContactEmail Address:
Printed Name and Title of Authorized Contractor Representative:
A ClientReference Name and Address:
B Phone Fax_2:
C Point of ContactEmail Address_2:
D Reference Contract Number:
Project Title:
Contract ValueType:
Period of Performance:
How long have you worked with the contractor:
More detailed description of the work performed:
Date Contractor Rep Signed:
Email Address for Responses:
A4-Acceptable: Off
A5-Acceptable: Off
A6-Acceptable: Off
A7-Acceptable: Off
A8-Acceptable: Off
A4-Unacceptable: Off
A5-Unacceptable: Off
A6-Unacceptable: Off
A7-Unacceptable: Off
A8-Unacceptable: Off
A1-Acceptable: Off
A2-Acceptable: Off
A3-Acceptable: Off
A1-Unacceptable: Off
A2-Unacceptable: Off
A3-Unacceptable: Off
B4-Acceptable: Off
B4-Unacceptable: Off
B1-Acceptable: Off
B2-Acceptable: Off
B3-Acceptable: Off
B1-Unacceptable: Off
B2-Unacceptable: Off
B3-Unacceptable: Off
C1-Acceptable: Off
C2-Acceptable: Off
C3-Acceptable: Off
C1-Unacceptable: Off
C2-Unacceptable: Off
C3-Unacceptable: Off
If additional remarks are necessary please attach an additional sheet:
Date Evaluation Completed_af_date:

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