Appendix A-1 - Past Performance Questionnaire - RFP 2025-R-007.pdf
PDF 1018 KB Posted
- Attached to
- Senate State Office AED & Fire Extinguisher Program Federal contract opportunity
- Solicitation number
- 2025-R-007
- Issued by
- United States Senate
About this file
This is a Past Performance Questionnaire (PPQ) template associated with Request for Quotation (RFQ) 2025-R-007 for the U.S. Senate Sergeant at Arms' Automated External Defibrillator & Fire Extinguisher Program.
The PPQ is a 5-page document that collects detailed performance ratings from previous clients of potential contractors. It includes sections for contract/project information, reference details, and evaluation criteria across 8 key performance areas: contract requirements fulfillment, delivery according to schedules, problem identification and correction, personnel expertise, key personnel management, program management effectiveness, cost management, and overall assessment. Ratings use a scale from Exceptional (EX) to Unsatisfactory (US), with detailed definitions provided for each rating level. The questionnaire concludes with yes/no questions about willingness to work with the contractor again and space for additional comments. The document is marked as Source Selection Information and requires completion within 5 days of receipt.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 2025-R-007 (RFQ) Statement of Work AED and Fire Extinguishers - Amend 001 (2.12.2025).pdf | ||
| Attachment C - AED and Fire Extinguisher Products Requirements Matrix.xlsx | XLSX spreadsheet | |
| Attachment F - Addendum to Commercial Agreements.pdf | ||
| Attachment E - Purchase Order Clauses.pdf | ||
| Attachment A - Office Locations.docx | DOCX document | |
| Attachment D - Section 208 Compliance Certificate.pdf | ||
| 2025-R-007 (RFQ) Statement of Work AED and Fire Extinguishers FINAL .pdf | ||
| Attachment B - 2025-R-007 (RFQ) AED and Fire Extinguisher Pricing Table.xlsx | XLSX spreadsheet |
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Text version
SOURCE SELECTION INFORMATION
PPQ V3 | May 2022
Appendix A-1
PAST PERFORMANCE QUESTIONNAIRE
The U.S. Senate Sergeant at Arms requests information in support of a source selection of Request for Quotation 2025-R-007 entitled Automated External Defibrillator & Fire Extinguisher Program.
When complete, the information on this form is SOURCE SELECTION INFORMATION and shall be protected as procurement sensitive information. Please complete this questionnaire and send within five
(5) days of receipt by email to:
acquisitions@saa.senate.gov
Attn: Nicole A. Barnes
Procurement and Contracting Specialist
A. Contract/Project/Task Order Information. Offeror must complete the information below regarding the contract on which the offeror is seeking a past performance reference:
Name of Offeror/Subcontractor: __________________________________________________
Contract/Task Order Number: _____________________________________________________
Contract Type: _________________________________________________________________
Project Name: _________________________________________________________________
Period of Performance: __________________________________________________________
Brief Description of Work:
mailto:acquisitions@saa.senate.gov
Appendix A-1
SOURCE SELECTION INFORMATION
PPQ V3 | May 2022
B. Reference Information. Reference must complete the information below regarding the contract on which the offeror is seeking a past performance reference:
Company/Agency Name: _________________________________________________________
Name of Person Completing Questionnaire: __________________________________________
Signature of Person Completing Questionnaire: _______________________________________
Your Role in Managing this Contract:_______________________________________________
Your Phone Number: ___________________________________________________________
Your Email Address: ____________________________________________________________
Time Period of Your Involvement with Contractor: ____________________________________
For each question posed below, please identify (highlight or underline) the response code which best reflects your experience with the referenced contract:
SOURCE SELECTION INFORMATION
PPQ V3 | May 2022 element contains a serious problem(s) for which the contractor’s corrective actions
Satisfactory --
US
performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.
S appear
N/A
VG
actions appear only marginally effective or were not fully implemented.
being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective.
or were ineffective.
Marginal -- Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated reflects a serious problem for
Company/Agency’s benefit. The contractual performance of the element or sub-element
Performance meets contractual requirements. The contractual
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-
Very Good -- Performance meets contractual requirements and exceeds some to the which the contractor has not yet identified corrective actions. The contractor’s proposed being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.
MG
Not Applicable or Not Observed
EX Exceptional -- Performance meets contractual requirements and exceeds many to the
Company/Agency’s benefit. The contractual performance of the element or sub-element
SOURCE SELECTION INFORMATION
PPQ V3 | May 2022
1. N/A
Comments:
EX MG US
fulfilling contract requirements and specifications.
2. Assess the ability of the contractor to deliver goods and services according to contract schedules.
Solicitation 2025-R-
Assess the contractor’s performance VG S
PAST PERFORMANCE QUESTIONNAIRE
Assess the contractor’s performance in
Assess the overall expertise, knowledge, and quality of assigned contractor personnel.
US
EX S
Comments:
Comments:
Comments:
MG US
VG
N/A
MG
3.
EX
VG MG N/A
N/A
VG
S identifying problems and taking corrective actions.
EX
4.
S US
SOURCE SELECTION INFORMATION
PPQ V3 | May 2022
EX
6.
Comments:
5.
VG
EX
selecting, retaining, supporting, and replacing, when necessary, key personnel.
VG
Comments:
Assess the effectiveness of the EX N/A contractor’s overall program
US
S US
management.
7. Assess the contractor’s effectiveness in VG S MG US
MG S N/A
MG
Assess the contractor’s performance in
US
forecasting and managing contractual costs.
8. EX VG S Overall assessment. N/A
N/A
Comments:
MG
Comments:
SOURCE SELECTION INFORMATION
PPQ V3 | May 2022
9.
10.
Would you contract with this contractor again? ( ) Yes ( ) No
If no, why not?
Please provide any further comments that are pertinent to the contractor’s performance.
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