C04_Attachment VI - Past Performance Questionnaire_1232SA26Q1203.doc
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- Attached to
- 1232SA26Q1203 - Combination Synopsis/Solicitation HVAC Maintenance-Services USDA-ARS-PWA Adams OR
- Solicitation number
- 1232SA26Q1203
About this file
This is a Past Performance Questionnaire template for RFP #1232SA26Q1203, a combined synopsis/solicitation issued by the USDA Agricultural Research Service for HVAC maintenance services at the Adams, Oregon site.
The questionnaire is designed to collect client references and performance feedback on contractor proposals. Contractors must complete Section 1 with company and project information, then distribute the form to their clients for completion of Section 2. Clients are asked to provide ratings on Technical Performance (overall performance, quality of work, schedule performance, cost performance, risk identification and mitigation, and likelihood of rehire) and Contractual Performance (overall contractual performance and likelihood of rehire). All ratings use a five-point scale (Excellent, Very Good, Good, Fair, Poor) with an N/A option. Completed questionnaires must be returned via email to theodore.blume@usda.gov. The solicitation itself covers one-year HVAC system and Alerton Building Automation System maintenance for all buildings, with all costs for biannual scheduled maintenance borne by the contractor. This is a Total Small Business Set-Aside (NAICS 811310, $12.5M size standard), with a site visit scheduled for September 3, 2026 at 10:00am PDT and questions closing September 9, 2026 at 10:00am PDT.
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Attachment VI
Request For Proposal (RFP) # 1232SA26Q1203 USDA-ARS-PWA SITE/Adams OR 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 theodore.blume@usda.gov
This will expedite the response from each referenced source.
CONTRACTOR COMPLETES SECTION 1. CLIENT POC COMPLETES SECTION 2.
SECTION 1:
Name of Contractor: ______________________________________________________
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:
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 DATE, and that a USDA representative may contact him/her sometime after that date?
FORMCHECKBOX
Yes FORMCHECKBOX No
SECTION 2:
Please BOLD the rating your Technical POC indicated he/she would give your project if contacted:
1. Overall Technical Performance
| Excellent |
| Very Good |
| Good |
| Fair |
| Poor |
| N/A |
2.
Quality of work
| Excellent |
| Very Good |
| Good |
| Fair |
| Poor |
| N/A |
3.
Schedule Performance
| Excellent |
| Very Good |
| Good |
| Fair |
| Poor |
| N/A |
4.
Cost Performance
| Excellent |
| Very Good |
| Good |
| Fair |
| Poor |
| N/A |
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
Please BOLD the rating your Contracting POC indicated he/she would give your project if contacted:
1.
Overall Contractual Performance
| Excellent |
| Very Good |
| Good |
| Fair |
| Poor |
| N/A |
2.
Would your Contracting POC use your company again? FORMCHECKBOX Yes FORMCHECKBOX No
Employee(s) who made the contact with above-named client references:
File details come from the government source that posted it. Updated .