Attachment 4 - Past Performance Questionnaire.pdf

Source Selection Information - See FAR 2.101 and 3.104 Controlled Unclassified Information

Past Performance Questionnaire Request For Quote (RFQ) # 1232SA25Q0288

Camfil CamControl and SafeScan Service and Technical Support

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.hassett@usda.gov no later than the closing date of the RFQ.

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, and that a USDA representative may contact him/her sometime after that date?

Yes No

SECTION 2: To be completed by the customer.

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

mailto:theodore.blume@usda.gov

Source Selection Information - See FAR 2.101 and 3.104 Controlled Unclassified Information

1. Overall Technical Performance

Excellent Very Good Satisfactory Marginal Unsatisfactory Poor N/A

2. Quality of work

Excellent Very Good Satisfactory Marginal Unsatisfactory Poor N/A

3. Schedule Performance

Excellent Very Good Satisfactory Marginal Unsatisfactory Poor N/A

4. Cost Performance

Excellent Very Good Satisfactory Marginal Unsatisfactory Poor N/A

5. Did the contractor proactively identify risk areas, mitigate risks, and respond to emergency and critical situations?

Yes No

6. Would you use this company again? Yes 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

Excellent Very Good Satisfactory Marginal Unsatisfactory Poor N/A

2. Would your Contracting POC use your company again? Yes No

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