Attachment A - PPQ.pdf

Title: Structural Repairs & Tunnel Improvements Location: Capitol Power Plant (CPP) Utility Distribution System (UDS) Tunnels

AOCACB21R0004

Revised 7 December 2011 36

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

ATTACHMENT A

AOC PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Firm Name: CAGE Code:

Address: DUNs Number:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture

Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work High Med Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name:

Title:

Phone Number:

Email Address:

Title: Structural Repairs & Tunnel Improvements IDIQ Location: Capitol Power Plant (CPP) Utility Distribution System (UDS) Tunnels

AOCACB21R0004

Revised May 2014 37

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: AOC REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND

SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE

COMPLETED QUESTIONNAIRE TO AOC WITH THEIR PROPOSAL, AND MAY

DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON AOC

SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES

DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED

DIRECTLY TO AOC. PLEASE CONTACT THE OFFEROR FOR AOC POC INFORMATION.

THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION

ON THIS FORM.