Attachment 5 - Past Performance Questionnaire (PPQ).docx

Past Performance Questionnaire 19AQMM26R0459

PAST PERFORMANCE QUESTIONNAIRE

Thank you for taking time to respond to this Questionnaire. The Contractor who forwarded this to you is competing for a contract with the Department of State. The contract will be to provide construction services at FASTC, 700 C Ave. Blackstone VA. The project will be replacing and moving safety barriers. Be aware that the terms of the contract require the CO to notify the contractor of any adverse ratings (Marginal or Unsatisfactory) in order for them to respond.

The information contained in the completed questionnaire is considered Source Selection Information (FAR 2.101 and FAR 3.104) and may not be released to the Firm/Company being rated.

The assessor should complete the Questionnaire and return to the Contracting Officer at BrownCL1@state.gov. Responses are due NOT LATER THAN 5:00 PM EDT on September 18, 2026. Please ensure to include Solicitation 19AQMM26R0459 and the name of the company being rated in the subject line.

CONTRACT INFORMATION:

a. Customer/Agency Name:

(Enter name of company being Rated)

b. Contract Number:

c. Type of Contract: (check all that apply)

Other:

d. Please complete the following:

Period of Performance: to Contract Number:

Initial Contract Value: $ Current (or Completed) Contract Value $ Two (2) points of contact (reference check):

Name:

Telephone Number:

Email:

Name:

Telephone Number:

Email:

e. Brief description of services:

f. Complexity of effort: ( ) Difficult ( ) Routine Comments:

EVALUATED BY:

We/I, the undersigned, being familiar with the work and the performing organization providing information about and have responded to the best of our/my knowledge and belief. We/I understand that a representative of the Department of State may contact us/me for confirmation of our/my responses to this questionnaire. Please provide the following information (to assist us in tracking responses received and resolving any conflicts in the evaluation process if necessary):

Name of Evaluator (Customer Contact):

Position Title/Grade:

Telephone Number:

Facsimile Number:

Organization/Office Symbol:

Mailing Address:

SCORING CRITERIA:

EXCEPTIONAL - Indicates the Contractor’s performance within the area of evaluation clearly and consistently exceeds contractual requirements.

ACCEPTABLE - Indicates no problems in area of evaluation or has only minor problems for which solutions were satisfactory.

UNACCEPTABLE - Indicates serious problems in the evaluation area. The Contractor is/was in danger of being unable to satisfy contractual requirements and timely recovery is not likely or did not occur.

I. QUALITY OF SERVICE

|_| Exceptional |_| Acceptable |_| Unacceptable Narrative:

II. TIMELINESS OF PERFORMANCE

|_| Exceptional |_| Acceptable |_| Unacceptable Narrative:

III. PRICE/COST CONTROL

|_| Exceptional |_| Acceptable |_| Unacceptable Narrative:

IV. BUSINESS RELATIONS (Ability to effectively manage contract.)

|_| Exceptional |_| Acceptable |_| Unacceptable Narrative:

V. CUSTOMER SATISFACTION

|_| Exceptional |_| Acceptable |_| Unacceptable Narrative:

VI. MANAGEMENT

|_| Exceptional |_| Acceptable |_| Unacceptable Narrative:

BASED ON THIS CONTRACTOR’S OVERALL PERFORMANCE, WOULD YOU AWARD THIS CONTRACTOR ANOTHER CONTRACT? YES |_| or NO |_| If no, please explain:

PLEASE PROVIDE ANY ADDITIONAL COMMENTS CONCERNING THE PAST PERFORMANCE OF THE CONTRACTOR:

Survey Completion Date:

Thank you for completing this past performance evaluation.

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND FAR 3.104 WHEN COMPLETED, FOR OFFICIAL USE ONLY