MACC_13_161_SOL_00015_PPQ_Only.doc

Solicitation Number: 13-161-SOL-00015

Multiple Award Construction Contract – (SFC) Albuquerque

Attachment 1: Past Performance Evaluation Questionnaire (PPQ)

Time Sensitive Instructions for Past Performance Reference: This would have sent to you directly from a prospective Offeror for this solicitation.

1. You have been designated as the point of contact for information relative to the past performance history/experience of an offeror competing in a Multiple Award Construction Contract – IDIQ, where the awarded firms will be eligible to compete for task orders covering a broad range of sanitation facility construction projects. The work will be on individual homes and communities on Indian Reservations served by the Albuquerque Area Indian Health Service within New Mexico, western Texas, southern Colorado and southeast Utah.

2. This PPQ document is in MS Word to facilitate ease of filling in. We would appreciate you converting this to PDF prior to emailing to the Contracting Officer of this project. Please complete the attached Past Performance Questionnaire from Section 2 on and return it to the Indian Health Service – Division of Engineering Services (IHS-DES) Contracting Officer at the e-mail address shown at the bottom of this page.

3. It is very important that you complete and return this Questionnaire at your very first opportunity. Please make every effort to be thorough in your answers/comments.

4. The information you provide is necessary and is considered an important component of the evaluation process. The information contained herein shall be treated as source selection sensitive and will not be provided to the Offeror’s of this solicitation or awarded contractor(s).

5. You may be contacted by the IHS-DES technical personnel during the course of the evaluation process for further information. In the event you are a Federal Agency and you have performance evaluation records generated under FAR 42.15, please forward these records to me concurrent with the return of this Questionnaire.

6. If you have any additional questions please contact me as shown below.

With appreciation for your time and attention, Sharon L. Dehnert Contracting Officer

IHS-DES

1301 Young Street, Suite 1071 Dallas, Texas 75202

PH: 214-767-8589

E-mail: Sharon.Dehnert@ihs.gov Past Performance Evaluation Questionnaire (PPQ)

Section 1 to be completed by the firm sending it to the past performance reference.

SECTION 1: CONTRACTOR INFORMATION

A. Contractor’s name and address:

B. Point of Contact:

C. Phone Number (with area code):

D. Contract Number:

E. Project Title or Description of Work performed under this project:

F. Contract Type:

Firm Fixed Price Indefinite Delivery/Indefinite Quantity Task Order

Cost Reimbursement

G. Project Award Date:

Schedule Completion Date:

Current/Final

Completion Date:

H. Project Award Amount:

Current/Final Project Amount:

I. Contractor being evaluated performed as the

Prime Contractor Subcontractor

Supplier on the contract/order

J. Authorization is hereby granted to provide the information requested in SECTION B of this Questionnaire.

(Signature) (Name and Title of Authorizing Official) (Date) SECTION 2: RESPONDENT INFORMATION (to be completed by the reference/respondent or client/customer of contractor/offeror)

EVALUATED BY

Firm Name & Address (Signature) (Date)

(Typed or Printed Name)

(Title) Phone Number:_____________________

Number of months evaluator worked on subject contract evaluated:

Section 3 – Performance Sub-factors

Unsatisfactory

Marginal

Satisfactory

Good

Outstanding x n

Circle the number on the scale of 1 to 5 that most accurately describes the contractor’s performance in the tabled performance factors.

Past Performance sub-factors

Performance Factors Continued next page

Past Performance Factors and sub-factors (cont)

REMARKS: utilize next and last blank page and reference performance area for augmenting remarks and particularly for ratings of Unsatisfactory or Marginal.

NOTE: Please list in the remarks other contracts/projects this contractor has completed for your firm or agency.

Section 4 NARRATIVE SUMMARY: You are encouraged to expand your comments using MS Word to elaborate.

1. What were the contractor’s greatest strengths in the performance of the contract?

2. What were the contractor’s greatest weaknesses in the performance of the contract?

3. Please provide any additional comment concerning the contractor’s performance on the last, blank page.

Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Circle answer No / Yes

If yes, please identify the type of termination: Default Convenience Pending Terminations

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc.)

Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in Remarks last page. Circle answer No / Yes Thank you for your prompt response and assistance!

DUE DATE NOTE: The firm that sent you this is responsible for following up and keeping you informed of any changes to the due date for getting this PPQ to the Indian Health Service.

Please return this completed questionnaire to: Before, June 21, 2013, 4:00 PM CDT.

Sharon Dehnert – Contracting Officer IHS Division of Engineering Services

1301 Young Street Suite 1071 Dallas, Texas 75202 Sharon.Dehnert@ihs.gov Please type ‘PPQ-MAC’ in email subject line.

Attachment 2: PPQ Log Distribution List To be returned with response package Part II -

Offeror Name ____________________________________________________

PPQ Form Provided To Reference

Name - Address

Offerors Signature __________________________________________________________

PPQ Form Provided To Reference

Name - Address

Offerors Signature __________________________________________________________