A6 - Past Performance Questionnaire.pdf

27 SOURCE SELECTION INFORMATION (SEE FAR 2.101 and 3.104)

PAST PERFORMANCE QUESTIONNAIRE

Instructions:

The USDA Forest Service is soliciting proposals for Solicitation No. 12445226R0007 – GAOA Lake Winfield Scott Campground Construction. As part of the procurement process, an emphasis is being placed on past performance as a source selection factor. In order to accurately evaluate the offeror’s past performance, your assistance is requested in obtaining and verifying the past performance history of this offeror.

Clients may return completed PPQ’s to the Contractor, or directly to the government. Clients who wish to submit their completed PPQ directly to the government may email the completed form to the Procurement Contracting Officer at penny.zortman@usda.gov. Please make the subject line of the email read 12445226R0007 - Past Performance Questionnaire – [Insert Evaluated Company’s Name]”. If submitting to the government directly, please respond by MONTH DAY, 2026 at 5:00 PM EST.

Contractor Information:

(To be completed by Contractor)

Firm Name:

Point of Contact at the Firm:

POC Phone Number:

POC Email:

Project Information:

(To be completed by Contractor)

Contract/Task Order Number:

Project Title:

Project Description:

Project Location:

Award Date: Completion Date: Actual Completion Date:

Explain Difference:

Original Contract Price: Final Contract Price:

Explain Difference:

Client’s Assessment of the Contractor (To be completed by Client)

Client Information:

Business/Organization Name:

Point of Contact for the Client:

Title:

Phone Number:

Email:

28 SOURCE SELECTION INFORMATION (SEE FAR 2.101 and 3.104)

Point of Contact’s Role in the Project:

Date Questionnaire Completed:

Client’s Signature:

Rating Scale:

Substantial Confidence:

(4)

Performance meets contractual requirements and exceeds many requirements that benefit the end user. Work was accomplished with few, if any, minor problems for which corrective actions taken by the contractor were highly effective. The offeror has been highly successful in performing the required effort.

Satisfactory Confidence (3)

Performance meets contractual requirements and exceeds some requirements that benefit the end user. Work was accomplished with some minor problems for which corrective actions taken by the contractor were effective. The offeror has successfully performed the required effort.

Limited Confidence (2)

Performance does not meet some contractual requirements. Serious problems with contractor performance were experienced for which the contractor has either not yet identified corrective actions or the corrective actions taken appear only marginally effective. The offeror has had little success performing the required effort.

No Confidence (1)

Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective. The offeror has not successfully performed the required effort

Not Applicable (N/A) Performance information is not recent or relevant as defined in the Solicitation. Unable to provide assessment.

Client’s Assessment of the Contractor, cont.

(To be completed by Client) Quality of Product or Service:

N/A 1 2 3 4

Quality of Deliverable (Met Specifications)

Conformance to good standards of workmanship

Adequacy of the QC Plan

Implementation of the QC Plan

Quality of QC Documentation

Identification/Correction of Deficient Work

Adequacy of Submittals

Use of Specified Materials

Comments:

Cost Control:

Ability to meet the terms and conditions within the contractually agreed

29 SOURCE SELECTION INFORMATION (SEE FAR 2.101 and 3.104) price(s)

Were invoices current, accurate, and complete

Reasonableness of price change proposals submitted

Proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

Schedule:

Adequacy of Initial Schedule

Adherence to Approved Schedule

Resolution of Delays

Timely submission of Required Documentation

Timely submission of Updated and Revised Schedules

Management / Business Relations:

Management of Resources/Personnel

Key Personnel were Utilized Appropriately and Effectively

Coordination and Control of Subcontractors

Professional Conduct

Review/Resolution of Subcontractor’s Issues

Change Order Activity (By Contractor)

Maintains an Adequate Work Force

Responsiveness to Corrective Actions

Identifies and Mitigates Risk

Regulatory Compliance:

Complied With Contract Clause Requirements

Complied With Reporting Requirements

Complied With Design Requirements

30 SOURCE SELECTION INFORMATION (SEE FAR 2.101 and 3.104)

Compliance With Labor Laws and Regulations

Complied With Safety Laws and Regulations

Correction Of Noted Deficiencies

Overall Rating:

Overall Rating

Recommendation:

Given what you know today about the contractor’s ability to perform the work required, would you recommend the selection of this firm for similar requirements in the future?

Would Would Not

Please use this space to provide additional comments, as needed. Identify Rating Category for each Comment.