Attach 005 - Past Performance Questionnaire.pdf
PDF 199 KB Posted
- Solicitation number
- 12443926Q0004
- Issued by
-
Department of Agriculture Forest Service
About this file
This is a Past Performance Questionnaire (PPQ) template used for solicitation 12443926Q0004, Attachment 005. The form collects historical performance information from contractors and references to evaluate their capability to successfully execute future federal contracts.
Section I requires contractors to provide company name, address, phone/fax, and point of contact information, along with authorization signature from an authorized representative. Section II requests detailed respondent information including the client/reference name and address, contact details, reference contract number, project title, contract value/type, period of performance, duration of working relationship, and a detailed description of work performed. Section III contains a comprehensive performance evaluation structured across three categories: Contract Performance (8 items addressing staffing, regulatory compliance, equipment maintenance, personnel management, safety/health/labor law compliance, subcontractor coordination, and overall performance); Quality of Service/Control (4 items evaluating quality standards, quality control plans, deficiency identification/correction, and overall workmanship); and Timeliness of Performance (3 items assessing schedule compliance, timely record submission, and delay resolution). Each evaluation item uses a binary rating scale of Acceptable (A) or Unacceptable (U), with Acceptable indicating the government has reasonable expectation of successful performance or performance record is unknown, and Unacceptable indicating no reasonable expectation of successful performance. A remarks section requires explanations 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:
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____________________________________________
E. Date completed: ___________________________________________________________________
Past Performance Evaluation Ratings Rating Description
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
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.
Solicitation No:
Attachment # cfulghum Highlight
SECTION III: PERFORMANCE EVALUATION
A. CONTRACT PERFORMANCE
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?
A U
3. Did the contractor exhibit knowledge of and compliance with government (or other) regulations and industry standards?
A U
4. How well did the contractor provide and properly maintain operational equipment throughout the term of the contract?
A U
5. Did the contractor demonstrate the ability to hire, maintain, and replace, if necessary qualified personnel during the contract?
A U
6. How well did the contractor comply with Environmental, health, labor laws, safety and security requirements?
A U
7. How well did the contractor coordinate and control subcontractors, if any? A U
8. Contractor’s Overall Performance A U
B. QUALITY OF SERVICE/CONTROL
1. Contractor’s accomplishment in meeting the quality standards A U
2. The contractor provided an effective quality control plan or inspection procedures to meet contract requirements? If no, please explain.
A U
3. Contractor identified and corrected deficient Work A U
4. Contractor’s Overall Quality of Workmanship A U
C. TIMELINESS OF PERFORMANCE
1. How well did the contractor comply with the contract schedule? A U
2. Did the contractor provide timely and accurate records, submittals, and/or reports? A U
3. How well did the contractor resolve any delays? A U
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.
ATTACHMENT 4 – Past Performance Questionnaire (PPQ)
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| B Phone Fax: |
| C Point of Contactemail address: |
| Date: |
| Printed Name and Title of Authorized Contractor Representative: |
| A ClientReference Name and Address 1: |
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| B PhoneFax: |
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| How long have you worked with the contractor: |
| More detailed description of the work performed: |
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| remarks are necessary please attach an additional sheet 3: |
| remarks are necessary please attach an additional sheet 2: |
| remarks are necessary please attach an additional sheet 1: |
| Text1: 12443926Q0004 |
| Text2: 005 |
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