ATTACHMENT 4_PPQ.docx

Past Performance Questionnaire Note: If offeror holds or has held other contracts with your agency/organization in the last three (3) years, please complete separate Past Performance Questionnaire forms for those contracts as well.

Section 1: Contract Identification

A. Contractor (Company/Division): __________________________________________________

B. Contractor Cage Code: __________________________________________________________

C. Contract Number: ______________________________________________________________

D. Period of Performance: ____________________________________________

H. Description of work performed:

I. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Section 2: Customer or Agency Identification

A. Customer or agency name: _______________________________________________________

B. Customer or agency description (if applicable): _______________________________________

C. Government official’s name: ____________________________________________________________

D. Government official’s title: _____________________________________________________________

E. Government official’s phone number/e-mail address: ______________________________________

F. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role: __________________________________________________________

G. Other suggested points of contact: __________________________________________________

Section 3: Performance Information

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block.

☐ EXCEPTIONAL – Performance meets contractual requirements and exceeds many requirements to the Government’s benefit. The contractual performance being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

☐ SATISFACTORY – Performance meets contractual requirements. The contractual performance being assessed contains some minor problems for which corrective actions taken by the contractor appear or was satisfactory.

☐ UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.