Attach 4 12445025Q0033_Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

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 Choose the number on the scale of 1 to 5 that most accurately describes the contractor’s performance or situation. Alternatively, select N/A where appropriate.

Rating Description

1 = Unsatisfactory Performance did not meet most contractual requirements. There were serious problems and the contractor’s corrective actions were ineffective

2 = Marginal Performance did not meet some contractual requirements. There were problems, some of a serious nature, for which corrective action was only marginally effective.

3 = Satisfactory Performance met contractual requirements. There were some minor problems and corrective actions taken by the contractor were satisfactory.

4 = Very Good Performance met all contract requirements and exceeded some to the government’s benefit. There were a few minor problems, which the contractor resolved in a timely, effective manner.

5 = Exceptional Performance met all contract requirements and exceeded many to the government’s benefit. Problems, if any, were negligible and were resolved in a timely, highly effective manner.

N/A = Neutral or N/A No record of past performance, the record is inconclusive, or rated area is not applicable

SECTION I: CONTRACTOR INFORMATION

SECTION III: PERFORMANCE EVALUATION

REMARKS: Please provide a narrative explanation for any ratings of 1 or 2.