PPQ.pdf

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 HFaisal@usagm.gov (Phone: 202-418-0932).

This will expedite the response from each referenced source. The contractor is required to submit three references from different clients. Please Refer to the Evaluation Factors, Factor 2 – Past Performance for details.

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Firm Name:

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:

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

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

8. Client’s Signature:

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S

PERFORMANCE

1. Quality of Service and Technical Expertise

Compliance with contract requirements; customer satisfaction E G A UA

2. Timeliness of Performance

Reliable; responsive to technical direction; adhered to contract schedule; tasks completed/provided on-time; no history of significant performance penalties.

Please include any information that fir this section.

E G A UA

3. Business Relations

Business Relations – Effective and efficient management; businesslike correspondence; responsive to contract requirements; prompt notification of problems; flexible; pro-active; responsive to inquiries, prompt notification of problems and problem resolution, customer satisfaction, effective and efficient contractor recommended solutions.

E G A UA

4. Personnel Management a)Work force properly trained and given proper direction to ensure that required tasks are successfully performed.

E G A UA

b) If this is/was a government contract, has/was this contract been partially or completely terminated for default or convenience, or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

Yes No

c) Have there been any indications that the contractor has had any financial problems?

If yes, please explain below.

Yes No

6. SAFETY/SECURITY

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes:

following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

E G A UA

b) Contractor complied with all security requirements for the project and personnel security requirements.

E G A UA

7. GENERAL

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

E G A UA

b) Compliance with contractual terms/provisions (explain if specific issues) E G A UA

c) Would you hire or work with this firm again? (If no, please explain below) Yes No

d) In summary, provide an overall rating for the work performed by this contractor. E G A UA

Please provide responses to the questions above (if applicable) and/or additional remarks.

Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

E = Excellent G = Good A = Acceptable UA = Unacceptable U = Unsatisfactory

TO BE COMPLETED BY CLIENT