Attachment 10 - AE IDIQ PPQ Request 6-2-25.docx

FA488725R0005

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

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 - Original (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:

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: THE GOVERNMENT REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO THE GOVERNMENT WITH THEIR PROPOSAL. 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

significant weaknesses identified.

which corrective actions taken by the Contractor were effective.

A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been no significant weaknesses identified.

Satisfactory solely for not performing beyond the requirements of the contract.

fully implemented.

A Marginal rating is appropriate when a significant event occurred from which the Contractor had trouble overcoming and that impacted the Government/Owner.

serious magnitude that it alone constitutes an Unsatisfactory rating.

(N) Not Applicable

negative.

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING THAT BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. 1. QUALITY

Please provide comments to justify the overall quality rating:

2. SCHEDULE

Please provide comments to justify the schedule rating:

3. COST CONTROL

Please provide comments to justify the cost control rating:

4. MANAGEMENT

Please provide comments to justify the management rating:

5. SMALL BUSINESS SUBCONTRACTING

Please provide comments to justify the small business subcontracting rating:

6. REGULATORY COMPLIANCE

Please provide comments to justify the regulatory compliance rating:

7. RECOMMENDATION

Would you hire or work with this firm again? (If no, please explain below) Comments:

Yes

No

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 that may assist our office in evaluating performance risk (please attach additional pages if necessary):