J10 Past Performance Questionnaire.docx
DOCX document 29 KB Posted
- Attached to
- Multi-Door Replacement & Repair Federal contract opportunity
- Solicitation number
- 75H70125R00065
About this file
The document is a Past Performance Questionnaire (PPQ) form for solicitation 75H70125R00065, designed to capture detailed performance evaluations for a federal contract. The form provides a comprehensive assessment framework for rating contractor performance across seven key areas: quality, schedule/timeliness, customer satisfaction, management/personnel, cost/financial management, safety/security, and general performance. Ratings range from Exceptional (E) to Unsatisfactory (U), with specific criteria for each rating level, allowing clients to provide nuanced feedback on a contractor's past work.
The related federal contract opportunity is for Multi-Door Replacement & Repair at the Quentin N Burdick Memorial Health Care Facility in Belcourt, North Dakota. The project involves repairing or replacing multiple doors, with a period of performance of 180 days and a contract value between $100,000 and $250,000. The contract is firm-fixed-price and issued by the Department of Health and Human Services Indian Health Service, targeting facility improvements at the specified location in Rolette County.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B05 Amendment 2 QAs.pdf | ||
| B01 75H70125R00065 RFP MDRR.pdf | ||
| J09 Company Specialized Experience Form Construction.pdf | ||
| J05 Self Performed Calculation Sheet.docx | DOCX document | |
| J06 Price Schedule MDRR.xlsx | XLSX spreadsheet | |
| J02 Design Package Multi-Door Replacement Repair.pdf | ||
| J07 WH-347 Payrolls Exp 31Jan2028.pdf | ||
| J03 Wage Det ND20250029 1Aug2025.pdf | ||
| J08 Release of Claims.docx | DOCX document | |
| J04 IHS IEE Representation Form MDRR.pdf | ||
| J01 SOW_Multi-Door Replacement Repair.pdf |
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Text version
Attachment J10. Past Performance Questionnaire (PPQ) Form PPQ
Volume I – Factor 2 – Past Performance
FOR OFFICIAL USE ONLY, SOURCE SELECTION INFORMATION (FAR 3.104)
Response to Solicitation 75H70125R00065
(Cover page not required in submission)
ATTACHMENT J10 SOLICITATION 75H70125R00065
COMPANY EXPERIENCE FORM (PAST PERFORMANCE)
PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)
CONTRACT INFORMATION (Contractor to complete Blocks 1-4)
| 1. Contractor Information | |
| Firm Name: | CAGE Code: |
| Address: | UEI: |
Phone Number:
Email Address:
Point of Contact: Contact Phone Number:
2. Work Performed as: |_| Prime Contractor |_| Sub Contractor |_| Joint Venture |_| Other (Explain) Percent of project work performed:
If subcontractor, who was the prime (Name/Phone #):
3. Contract Information Contract Number:
Delivery/Task Order Number (if applicable):
Contract Type: |_| Firm Fixed Price |_| Cost Reimbursement |_| Other (Please specify):
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:
| 4. 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.)
CLIENT INFORMATION (Client to complete Blocks 5-8)
5. Client Information Name:
Title:
Phone Number:
Email Address:
6. Describe the client’s role in the project:
7. Date Questionnaire was completed (mm/dd/yy):
8. Client’s Signature:
NOTE: IHS DES REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO IHS WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON IHS SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO IHS. PLEASE CONTACT THE OFFEROR FOR IHS POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.
ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT
YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE
RATING DEFINITION NOTE
| (E) Exceptional |
| Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| To justify an Exceptional rating, identify multiple significant events and state how they were of benefit to the Government. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified. |
| (VG) Very Good |
| Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| To justify a Very Good rating, identify a significant event and state how it was a benefit to the Government. There should have been no significant weaknesses identified. |
| (S) Satisfactory |
| Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory. |
| To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract/order. There should have been NO significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be evaluated with a rating lower than Satisfactory solely for not performing beyond the requirements of the contract/order. |
| (M) Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented. |
| To justify Marginal performance, identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the Government. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter). |
| (U) Unsatisfactory |
| Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. |
| To justify an Unsatisfactory rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the Government. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g., management, quality, safety, or environmental deficiency reports, or letters). |
| (N) Not Applicable |
| No information or did not apply to your contract |
| Rating will be neither positive nor negative. |
TO BE COMPLETED BY CLIENT
PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS
YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.
1. QUALITY:
| a) Quality of technical data/report preparation efforts |
| E VG S M U N |
| b) Ability to meet quality standards specified for technical performance |
| E VG S M U N |
| c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance |
| E VG S M U N |
| d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance) |
| E VG S M U N |
2. SCHEDULE/TIMELINESS OF PERFORMANCE:
| a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below) |
| E VG S M U N |
| b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract |
| E VG S M U N |
3. CUSTOMER SATISFACTION:
| a) To what extent were the end users satisfied with the project? |
| E VG S M U N |
| b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication) |
| E VG S M U N |
| c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer? |
| E VG S M U N |
| d) Overall customer satisfaction |
| E VG S M U N |
4. MANAGEMENT/ PERSONNEL/LABOR
| a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force? |
| E VG S M U N |
| b) Ability to hire, apply, and retain a qualified workforce to this effort |
| E VG S M U N |
| c) Government Property Control |
| E VG S M U N |
| d) Knowledge/expertise demonstrated by contractor personnel |
| E VG S M U N |
| e) Utilization of Small Business concerns |
| E VG S M U N |
| f) Ability to simultaneously manage multiple projects with multiple disciplines |
| E VG S M U N |
| g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes |
| E VG S M U N |
| h) Effectiveness of overall management (including ability to effectively lead, manage and control the program) |
| E VG S M U N |
5. COST/FINANCIAL MANAGEMENT
| a) Ability to meet the terms and conditions within the contractually agreed price(s)? |
| E VG S M U N |
| b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client |
| E VG S M U N |
| c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns) |
| E VG S M U N |
| d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section. |
| Yes No |
| e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below. |
| Yes No |
| f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below. |
| Yes No |
6. SAFETY/SECURITY
| a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.) |
| E VG S M U N |
| b) Contractor complied with all security requirements for the project and personnel security requirements. |
| E VG S M U N |
7. GENERAL
| a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues). |
| E VG S M U N |
| b) Compliance with contractual terms/provisions (explain if specific issues) |
| E VG S M U N |
| c) Would you hire or work with this firm again? (If no, please explain below) |
| Yes No |
| d) In summary, provide an overall rating for the work performed by this contractor. |
| E VG S M U N |
Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):
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