Attach 4 - PPQ Questionnaire.docx

Past Performance Questionnaire 21 June 2022

TO:

SUBJECT: Request for Past Performance Evaluation You have been identified as a point of contact for a past and/or present performance evaluation of the firm listed on the attached questionnaire. This firm is currently being considered for a David Grant Medical Center Laundry Services contract at Travis AFB, CA.

Your prompt attention to this questionnaire will be greatly appreciated. If you have any questions concerning this request, I can be contacted at .

Please submit completed questionnaire to the Government Contract Specialist identified on the attached questionnaire.

Contractor Signature

Enclosed:

1 - Past Performance Questionnaire

I. GENERAL INFORMATION: To be Completed by the Contractor

A. Offeror Information:

Name (Company/Division): CAGE Code: DUNS Number: If Other than the Prime Offeror, Identify Prime Offeror:

B. Program Title:

C. Contract Specifics:

Has the contract been entered into the Contractor Performance Assessment Reporting System (CPARS)?

D. Description of Contract as Prime or _ Subcontractor Indicate the type of services provided and highlight portions considered most relevant to the Base Linen Exchange acquisition.

F. Number of building pickup/delivery locations :

NOTE: Buildings may only be counted once, even if they may be cleaned more than once on a weekly basis. For example, if building 595 is cleaned 3 times a week, it would still only be counted as 1 building.

II. RESPONDENT INFORMATION:

To Be Completed/Accomplished By the Respondent

Name of Respondent: Title: Address: Telephone Number: Fax Number: Email Address:

Is the information provided by the Contractor in Section I, General Information accurate? Yes No If not explain which information is not accurate:

C. SEND COMPLETED SURVEY FORM TO ALL THE EMAIL ADDRESS BELOW:

Enclosure 1

III. PERFORMANCE INFORMATION:

To Be Completed/Accomplished By the Respondent

Choose the appropriate letter on the scale (E, G, S, M, U, N) that most accurately describes the contractor’s performance or situation or N/A if performance in this area is not applicable to the effort addressed.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

Performance meets contractual requirements and exceeded many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.

Performance meets contractual requirements and exceeded some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.

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 were satisfactory.

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

CONTRACTOR’S NAME: CONTRACT #:

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

3.

How well did the contractor attract and retain qualified and fully trained personnel within their organization to ensure contract compliance?

process meet contractual requirements?

YES/NO

Remarks (provide detail regarding unfavorable ratings, especially those concerning performance at child development centers and youth centers and fitness centers):