Attachment_3_-_Past_Performance_Questionnaire_(PPQ).docx

Past Performance Questionnaire (PPQ) Solicitation Number: 140D0421Q0335

Brief Description of Work Being Procured:

The Department of the Interior (DOI), Interior Business Center (IBC), Acquisition Services Directorate (AQD) is seeking past performance information under RFQ 140D0421Q0335 - National Rehabilitation Information Center (NARIC) requirement.

In order to assess potential Offerors under this solicitation, the DOI/IBC/AQD contracting office is obtaining past performance information with respect to each Offeror in the performance of the work described above. As a reference for work performed by the firm identified below of this questionnaire, your candid response will assist in the evaluation process. Please complete the questionnaire as thoroughly as possible.

Please complete and sign. References are to submit a fully completed questionnaire to the Contracting Specialist, with the Contracting Officer cc’d, via email no later than the closing date and time of the 11:00AM due date of June 23, 2021. Questionnaires should be submitted to:

Contract Specialist ___________ (email: ___________@ibc.doi.gov) and Contracting Officer Matthew Mosellen (email: matthew_mosellen@ibc.doi.gov).

The email message shall originate from the reference's government or commercial e-mail system. If you have questions, please contact Matthew Mosellen at matthew_mosellen@ibc.doi.gov.

I. Contract Information

a. Company Being Evaluated:

b. Address:

c. Contract Number:

d. Contract Type:

e. Period of Performance (including options):

f. Total Contract Value:

g. Award Information:

Competitive: ( ) Yes ( ) No Basis of Selection: ( ) Technical ( ) Cost/Price ( ) Other (specify):

II. Description of Contract (Briefly describe the services provided under this contract):

III. Under the aforementioned contract, this firm was:

( ) Prime Contractor ( ) Subcontractor ( ) Team Member

IV. Does a corporate or business relationship exist between the firm being evaluated and your organization? If yes, please explain.

( ) Yes ( ) No

V. Evaluator Information

a. Name:

b. Title:

c. Agency/Company:

d. Phone:

e. Role in Program Contract:

f. Length of Involvement in this Program/Contract:

VI. Performance Survey The following are the definitions for the rating system being used:

Excellent (E); Very Good (VG); Good (G); Fair (F); Pass (P); Not Required (NR)

VII. Overall Contract Performance Rating Based on the scoring above:

( ) Excellent ( ) Very Good ( ) Good ( ) Fair ( ) Poor

VIII. Would you select this contractor again?

( ) Yes ( ) No

IX. Please add any other comments you may feel are pertinent.

IX. Signature

I affirm the above comments are accurate.

Rater’s Signature Date