ATTACHMENT 2 (PART 1 of 2) USDA CONSTRUCTION PAST PERFORMANCE QUESTIONNAIRE (fillable).pdf

USDA CONSTRUCTION PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0) CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Firm Name: CAGE Code:

Address:

Phone Number:

DUNs Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub-Contractor: Joint Venture Other:

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:

Contract Title: Contract Location:

Award Date: Contract Completion Date: Actual Completion Date:

Original Contract Price (Award Amount): Final Contract Price (to include all mods):

4. Project Description: Complexity of Work High Medium Routine

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:

8. Client’s Signature:

NOTE: USDA REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR.

THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO USDA WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS

QUESTIONNAIRE FOR FUTURE SUBMISSION ON USDA SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO USDA. PLEASE

CONTACT THE OFFEROR FOR USDA POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL

INFORMATION ON THIS FORM.

USDA South Building Wings 6 & 7 Design-Build Modernization Solicitation # 12314421R0006ATTACHMENT 2 (PART 1 of 2)