Past_Performance_Questionaire_(PPQ).pdf

PBS PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor/Offeror to complete Blocks 1-4)

1. CONTRACTOR/OFFEROR

INFORMATION Firm Name:

Address:

Phone Number: DUNs Number:

Contact Name

Email Address: : Contact Phone Number:

GENERAL WORK INFORMATION

Work performed as: Prime Contractor Sub Contractor Joint Venture Other (Please explain):

Percent (%) of project work performed:

If a subcontractor, who was the prime (Name/Phone #):

CONTRACT INFORMATION

Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please explain)

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date

(mm/dd/yy): Actual Completion Date

(mm/dd/yy): Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable): Explain Differences:

PROJECT DESCRIPTION

Complexity of Work: High Med Routine

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)