Attachment 7- Lake Pow WWTP Decomm PPQ Template.docx

Past Performance Questionnaire

Instructions:

The USDA Forest Service is soliciting proposals for Solicitation No. 12445226Q0007 – Lake Powhatan WWTP Disaster Recovery Decommissioning and Sewer Connection. As part of the procurement process, an emphasis is being placed on past performance as a source selection factor. In order to accurately evaluate the offeror’s past performance, your assistance is requested in obtaining and verifying the past performance history of this offeror.

Clients may return completed PPQ’s to the Contractor, or directly to the government. Clients who wish to submit their completed PPQ directly to the government may email the completed form to the Contracting Officer, Jalisa Sims at Jalisa.sims@usda.gov and Source Selection Board Chair, Tim Heim, at Timothy.Heim@usda.gov. Please make the subject line of the email read “12445226Q0007- Past Performance Questionnaire – [Insert Evaluated Company’s Name]”. If submitting to the government directly, please respond by March 2, 2026 at 5:00 PM EST.

Contractor Information:

(To be completed by Contractor)

Firm Name:

Point of Contact at the Firm:

POC Phone Number:

POC Email:

Project Information:

(To be completed by Contractor)

Contract/Task Order Number:

Project Title:

Project Description:

Project Location:

Award Date:

Completion Date:

Actual Completion Date:

Explain Difference:

Original Contract Price:

Final Contract Price:

Explain Difference:

CLIENT’S ASSESSMENT OF THE CONTRACTOR

(To be completed by Client)

Client Information:

Business/Organization Name:

Point of Contact for the Client:

Title:

Phone Number:

Email:

Point of Contact’s Role in the Project:

Date Questionnaire Completed:

Client’s Signature:

Rating Scale:

EXCEPTIONAL

(5) Performance EXCEEDS MOST contractual requirements to the Government’s benefit. The performance of areas being assessed was accomplished with few minor issues or concerns.

VERY GOOD

(4) Performance EXCEEDS SOME contractual requirements to the Government’s benefit. The performance of areas being assessed was accomplished with few minor issues or concerns, for which the Contractor’s corrective actions were highly effective.

SATISFACTORY

(3) Performance MEETS contractual requirements. The performance of the areas being assessed contains minor issues or concerns, for which corrective actions taken by the Contractor were effective.

MARGINAL

(2) Performance MEETS SOME contractual requirements. The performance of the areas being assessed includes significant problems, issues, or concerns for which corrective actions taken by the Contractor were only somewhat effective.

UNSATISFACTORY

(1) Performance DOES NOT MEET contractual requirement. The performance of the areas being assessed includes serious problems, issues, or concerns for which the Contractor’s corrective actions were ineffective.

CLIENT’S ASSESSMENT OF THE CONTRACTOR, CONT.

(To be completed by Client) Quality of Product or Service:

Quality of Deliverable (Met Specifications)

Conformance to good standards of workmanship

Adequacy of the QC Plan

Implementation of the QC Plan

Quality of QC Documentation

Identification/Correction of Deficient Work

Adequacy of Submittals

Use of Specified Materials

Comments:

Cost Control:

Ability to meet the terms and conditions within the contractually agreed price(s)

Were invoices current, accurate, and complete

Reasonableness of price change proposals submitted

Proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

Comments:

Schedule:

Adequacy of Initial Schedule

Adherence to Approved Schedule

Resolution of Delays

Timely submission of Required Documentation

Timely submission of Updated and Revised Schedules

Comments:

Management / Business Relations:

Management of Resources/Personnel

Key Personnel were Utilized Appropriately and Effectively

Coordination and Control of Subcontractors

Professional Conduct

Review/Resolution of Subcontractor’s Issues

Change Order Activity (By Contractor)

Maintains an Adequate Work Force

Responsiveness to Corrective Actions

Identifies and Mitigates Risk

Comments:

Regulatory Compliance:

Complied With Contract Clause Requirements

Complied With Reporting Requirements

Complied With Design Requirements

Compliance With Labor Laws and Regulations

Complied With Safety Laws and Regulations

Correction Of Noted Deficiencies

Comments:

Overall Rating:

Overall Rating

Comments:

Recommendation:

Please use this space to provide additional comments, as needed. Identify Rating Category for each Comment.

Source Selection Information - See FAR 2.101 and 3.104