Attachment IV Past Performance Questionaire (PPQ).doc

RFQ # 12905B21Q0057

Removal and Replacement of Boiler in Prosser, WA Attachment IV

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

The Contractor shall complete the company specific information on this form, contact their clients, forward this form to their clients and request that their clients complete it (verify/concur and score) and send it via email to lam.pham@usda.gov

This will expedite the response from each referenced source.

Name of client organization:

Project name and contract/task order number:

Brief description of support provided:

Total period of performance, dates, and total cost/price:

Number of contractor personnel assigned to the project, by skill category:

SECTION 1:

Name and Title of Technical Point of Contact (POC):

Address of Technical POC:

Telephone number of Technical POC:

Date the Technical POC was contacted for this PPQ:

Did you inform your client that a past performance questionnaire must be completed and returned to USDA by August 03, 2021 and that a USDA representative may contact him/her sometime after that date?

FORMCHECKBOX

Yes FORMCHECKBOX No

Please BOLD the rating your Technical POC indicated he/she would give your project if contacted:

1. Overall Technical Performance

2.

Quality of work

3.

Schedule Performance

4.

Cost Performance

5.

Did the contractor proactively identify risk areas, mitigate risks, and respond to emergency and critical situations? FORMCHECKBOX Yes FORMCHECKBOX No

6.

Would your Technical POC use your company again? FORMCHECKBOX Yes FORMCHECKBOX No

SECTION 2:

Name and Title of Contracting Point of Contact (POC):

Address of Contracting POC:

Telephone number of Contracting POC:

Date the Contracting POC was contacted for this PPQ:

Did you inform your client that a past performance questionnaire must be completed and returned to USDA by August 03, 2021 and that a USDA representative may contact him/her sometime after that date?

FORMCHECKBOX

Yes FORMCHECKBOX No Please BOLD the rating your Contracting POC indicated he/she would give your project if contacted:

1.

Overall Contractual Performance

2.

Would your Contracting POC use your company again? FORMCHECKBOX Yes FORMCHECKBOX No

Employee(s) who made the contact with above-named client references: