Attachment D.6 - Past Performance Questionnaire (PPQ).docx

FOR OFFICIAL USE ONLY

Source Selection Sensitive Information—See FAR 2.101 & 3.104 Attachment D.6

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS TO CONTRACTOR

Complete the CONTRACTOR INFORMATION section, below (type answers into light blue shaded boxes). Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions.

INSTRUCTIONS TO REFERENCE CONTACT

The contractor named below is submitting an offer for a United States Department of Veterans Affairs contract requirement and has sent this form to you for a past performance contract reference. Please complete this form in full (all areas shaded in light yellow). Once completed, please send the form to the Contracting Officer / Contract Specialist via email: Andrew.Schoenecker@va.gov / Lenny.Flagg@va.gov

Department of Veterans Affairs - PCAC ATTN: Lenny Flagg, Reference: RFP 36C77623R0108 Email Address: Lenny.Flagg@va.gov

Please return the completed form no later than the date and time set for receipt of Proposals. If you have any questions, please contact Lenny Flagg via email. Thank you for your assistance in this matter.

GENERAL INFORMATION [completed by Contractor/Offeror]

Contractor Company Name

Street Address

Contractor Point of Contact Name

City

Point of Contact Phone Number

State

Reference Project / Contract Title

Zip Code

Contract Period of Performance (start to finish):

Email

Contract Number

Contract Dollar Value

Detailed Description of Work Performed

RESPONDENT INFORMATION [completed by Reference Contact]

Company Name

Street Address

POC Name

City

Phone Number

State

Fax Number

Zip Code

Email

PERFORMANCE INFORMATION – Table 1: Choose the number on the scale of 1 to 4 that most accurately describes the contractor’s performance.

PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY NEGATIVE RATING(S) in the Remarks section, below (text box will expand to whatever extent is necessary). Please provide a narrative explanation for any Ratings of 1 or 2 in the Remarks section below.

PERFORMANCE INFORMATION – Table 2: Please answer the following questions regarding personnel.

Please provide any comments, narratives, or explanations on personnel below in the Remarks section (text box will expand to whatever extent is necessary).

8.

Was the contractor ever issued a letter of concern, cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

REMARKS (Please use as much space as is needed – the box will expand as you type).