1202SC24Q2700 Attachment 5 Past Performance Questionnaire.pdf

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Attached to
Laundry Service for Northwest Area Incident Support Cache Redmond Air Center
Solicitation number
1202SC24Q2700
Issued by

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This document is a past performance questionnaire template for the solicitation numbered 1202SC24Q2700 from the Department of Agriculture Forest Service. The solicitation is for laundry services for the Northwest Area Incident Support Cache Redmond Air Center. Respondents are requested to provide references who will receive and complete the past performance questionnaire, rating the contractor's performance on factors such as working relationships, regulatory compliance, operational equipment maintenance, personnel management, environmental and safety compliance, subcontractor management, and overall performance. References will also rate the contractor's quality of service and control through measures including quality standards achievement, quality control plans, workmanship, schedule compliance, reporting timeliness, and delay resolution. Ratings are on an Acceptable/Unacceptable scale, with remarks required for any Unacceptable ratings.

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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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