Attachment_5_Past_and_Present_Performance_Questionnaire.doc

When Filled In This Document Is Source Selection Sensitive IAW FAR 2.101 and FAR 3.104 Attachment 5, Solicitation AG-91S8-S-17-0013, HVAC Design US Forest Service Region 5 Building

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Contractor’s responding to Solicitation AG-91S8-S-17-0013 shall send this Past Performance Questionnaire for their references to fill out.

A. CONTRACT IDENTIFICATION:

Contractor Name: ______________________________

Contract Number: ______________________________

Point of Contact: _______________________________ Telephone Number: _____________________________

Email: ________________________________________ Period of Performance: ___________________________ Initial Contract Cost: $___________________________

Current/Final Cost: $_____________________________ Project Title and Brief Description of Work: ___________________________________________

Contractor performed as the ( Prime Contractor ( Sub-Contractor ( Key Personnel.

B. RESPONDENT INFORMATION:

“Respondent = Name of the Reference filling out the Questionnaire” Name of Respondent: ____________________________ Title: _________________________________________ Telephone Number: _____________________________

Email: ________________________________________ Note to contractor: Please ensure you instruct the respondent to email completed questionnaire prior to the stated submission date above.

CONTRACTOR’S NAME: ________________________________

CONTRACT NUMBER: __________________________________

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

A. PERFORMANCE INFORMATION: Choose the appropriate number on the scale (1, 2, 3, 4, and 5) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION ON THE ADDIONAL REMARKS SECTION FOR ANY RATINGS OF 4 or 5.

Place an “X” in the appropriate column using the definitions matrix above.

Additional Remarks E-MAIL COMPLETED PPQ SURVEY FORM TO: Respondent shall email completed survey to Dindo Laxamana, 707-562-9022, email: dindolaxamana@fs.fed.us. Send no later than the close date of May 15, 2017, 4:00 pm PST.