Attachment 3 - Past Performance Questionnaire (PPQ).doc

Past Performance Questionnaire Request For Quote (RFQ) # 12905B25Q0002 Dry Ice and Gas Cylinder Contract for USDA-ARS at Albany, CA Attachment 3

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

The Contractor shall complete the company specific information on this form, contact their clients, forward this form to their clients and request that their clients complete it (verify/concur and score) and send it via email to Michael.Sherlock@usda.gov; Michael.Hassett@usda.gov .

This will expedite the response from each referenced source.

SECTION 1: To be completed by the contractor Name of Contractor:

Name of client organization:

Project name and contract/task order number:

Brief description of support provided:

Total period of performance and dates Total cost/price:

Number of contractor personnel assigned to the project, by skill category:

Name and Title of Technical Point of Contact (POC) for the customer:

Address of Technical POC:

Email and telephone number of Technical POC:

Date the Technical POC was contacted for this PPQ:

Did you inform your client that a past performance questionnaire must be completed and returned to USDA by 10/24/2024, and that a USDA representative may contact him/her sometime after that date?

FORMCHECKBOX

Yes FORMCHECKBOX No

SECTION 2: To be completed by the customer.

Please BOLD the rating indicating your projects rating in the following areas:

1. Overall Technical Performance

2.

Quality of work

3.

Schedule Performance

4.

Cost Performance

5.

Did the contractor proactively identify risk areas, mitigate risks, and respond to emergency and critical situations? FORMCHECKBOX Yes FORMCHECKBOX No

6.

Would you use this company again? FORMCHECKBOX Yes FORMCHECKBOX No

SECTION 3: To be completed by the customer’s contracting office (If different from TPOC in section 1).

Name and Title of Contracting Point of Contact (POC):

Address of Contracting POC:

Telephone number of Contracting POC:

Date the Contracting POC was contacted for this PPQ:

Section 4: Please BOLD the rating your Contracting POC (or TPOC if there isn’t a contracting POC) indicated he/she would give your project if contacted:

1.

Overall Contractual Performance

2.

Would your Contracting POC use your company again? FORMCHECKBOX Yes FORMCHECKBOX No

Contracting POC Signature (TPOC if contracting POC is N/A)