Attachment 10 - PPI Questionnaire.pdf

As of: 12/22/2021

Once this document has been completed, the information contained becomes Source Selection Sensitive.

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104.

Attachment # Solicitation #

PAST PERFORMANCE INFORMATION (PPI) QUESTIONNAIRE – OFFEROR

The offeror is solely responsible for ensuring references complete and submit this questionnaire to the Government by the required due date.

Section 1

OFFEROR TO COMPLETE THIS SECTION:

Offeror Firm Name:

Offeror Firm Address:

Offeror Firm EIN:

Offeror Firm Email:

Offeror Firm Phone:

Offeror Firm FAX:

We are in the process of preparing our proposal for DLA Disposition Services’ Solicitation No.

_________________________, closing time and date ___________________________, to provide hazardous waste removal, transportation, & disposal services at _______________________________________. As part of our proposal we have listed you as a reference for work performed by our firm for your firm/Agency.

Your input on our performance is therefore requested. Please complete Section 2 of this document and then email the completed document (Sections 1 & 2) to ______________________________________________.

The Government must receive the completed document no later than the date offers are due. Thank you.

CUI

CUI

Controlled by: DLA Disposition Services (PH) CUI Category: SSEL Distribution/Dissemination Controls: FED ONLY

POC:

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104.

Attachment # Solicitation #

Contract #:

Role/Title for the Contract:

Email: Phone:

Section 1

OFFEROR TO COMPLETE THIS SECTION:

Reference Contract Title:

Reference POC Name:

How Long in this Role:

Firm/Agency Reference Works for:

Contract Performance Location:

Performance Start Date:

Total Contract Dollar Value: $ Description of Contract Requirements:

Contract Completion Date:

Hazardous Material/ Waste Streams Involved and Quantities/Volumes Disposed and Recycled:

Location of Pickup Point(s) or Other Services:

Frequency of Pickup(s) or Other Services (e.g. once a month):

Allowable Response Time after Notification for Performance (e.g., 30 days):

Types of Documents Contractor was required to Provide/Process (i.e. manifests, waste profiles, permits, etc.):

Significant Risks in Performance of the Contract:

What work was performed by the offeror?

or Contract Value with other Currency ___________________

CUI

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104.

Attachment # Solicitation #

Section 2

OFFEROR'S REFERENCE TO COMPLETE THIS SECTION:

Based on the following adjectival ratings scale, please evaluate the quality of the offeror’s performance by selecting the appropriate ratings and applying to elements I through V on the following pages.

SCALE:

NOT

APPLICABLE UNSATISFACTORY MARGINAL SATISFACTORY VERY GOOD EXCEPTIONAL

N/A 1 2 3 4 5

DEFINITIONS:

EXCEPTIONAL: Performance met and exceeded many contractual requirements. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VERY GOOD: Performance met and exceeded some contractual requirements. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

SATISFACTORY: Performance met contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

MARGINAL: Performance did 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.

The contractor’s proposed actions appear only marginally effective or were not fully implemented.

UNSATISFACTORY: Performance did not meet most contractual requirements and recovery in a timely manner is not likely. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’s corrective action(s) appear or was/were ineffective.

NOT APPLICABLE: Self-explanatory.

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104.

Attachment #

I. QUALITY OF PRODUCT/SERVICE

a. Compliance with contract requirements (to include regulatory compliance)

b. Accuracy of reports and documentation (e.g. manifests, bills of lading)

c. Manifesting and land disposal notifications (includes basal notifications)

d. Waste profiling

e. Compliance with transportation laws and regulations (DOT, maritime, foreign)

f. Packaging, labeling, and disposal

g. Demonstrated knowledge of hazardous waste laws and regulations

N/A 1 2 3 4 5

If assigning a rating of 2 or 1, please provide examples of how the contractor did not meet contract requirements:

If assigning a rating of 4 or 5, please provide examples of how the contractor exceeded contract requirements:

II. SCHEDULE

a. Adherence to transportation scheduling

b. Adherence to performance timeframes (removal of waste/Mgt services)

c. Adherence to performance timeframes (analysis)

d. Timeliness in submission of initial documentation/reports

e. Timeliness in submission of final documentation/reports

f. Advance notice and scheduling/receipt of correct and complete documents

N/A 1 2 3 4 5

If assigning a rating of 2 or 1, please provide examples of how the contractor did not meet contract requirements:

If assigning a rating of 4 or 5, please provide examples of how the contractor exceeded contract requirements:

Solicitation #

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104.

Attachment # Solicitation #

III. MANAGEMENT

a. Orientation toward the customer

b. Professionalism of staff

c. Interactions with the Government

d. Promptness in making notifications of problems encountered during performance

e. Flexibility and productiveness in problem solving

f. Effectiveness of corrective actions taken

N/A 1 2 3 4 5

If assigning a rating of 2 or 1, please provide examples of how the contractor did not meet contract requirements:

If assigning a rating of 4 or 5, please provide examples of how the contractor exceeded contract requirements:

SOURCE SELECTION INFORMATION - SEE FAR 2.101 and 3.104.

Solicitation #

IV. REGULATORY COMPLIANCE

a. Compliance with all contract clauses and reporting requirements (e.g., safety, environmental, EEO, trafficking in persons, etc.)

b. Compliance with transportation laws and regulations (DOT, maritime, foreign)

c. Demonstrated knowledge of hazardous waste laws and regulations

Attachment #

N/A 1 2 3 4 5

If assigning a rating of 2 or 1, please provide examples of how the contractor did not meet contract requirements:

If assigning a rating of 4 or 5, please provide examples of how the contractor exceeded contract requirements:

V. OTHER COMMENTS (Include overall comments regarding highly rated or poorly rated performance):

Would you recommend this contractor for potential future awards? (Please check one of the following)

DEFINITELY WOULD

PROBABLY WOULD

MIGHT OR MIGHT NOT

PROBABLY WOULD NOT

DEFINITELY WOULD NOT

If you have checked anything other than DEFINITELY WOULD recommend, please explain why: