Attachment_11_-_PPQ.DOCX

ATTACHMENT 11

PAST PERFORMANCE QUESTIONNAIRE

**When completed, this document is Source Selection Information IAW FAR 3.104**

SECTION 1: CONTRACT IDENTIFICATION (TO BE COMPLETED BY OFFEROR)

A. Contractor

B. Contractor Cage Code

C. Role (check): Prime Subcontractor Teaming Partner Joint Venture Partner Other (specify)

If subcontractor, partner or other, who is the Prime?

D. Contract/Blanket Purchase Agreement (BPA) Number

Task/Call/Delivery/Purchase Order Number

Note: Each PPQ shall cover actual work performed and not overarching contracts, such as Indefinite-Delivery Indefinite Quantity (IDIQ) basic contracts, Blanket Purchase Agreements (BPA), etc. (i.e., each PPQ shall only address one performance effort such as a TO for an IDIQ contract, a call order off of a BPA, or delivery order).

E. Contract Type (FFP, CPFF, ID/IQ (include types), LH, etc.)__________________________________________

F. Fuels and/or Supply Service Operations (circle more than one if applicable)

G. Period of Performance

H. Place(s) of Performance:

Multiple locations? Yes No If yes, specify locations:

CONUS OCONUS Both Provide details:

State Federal DoD Other Provide details:

I. Total Contract or Task/Call/Delivery/Purchase Order $ Value (including options)

J. Has a CPAR (or more than one CPAR) been completed for this contract? Yes No If Yes, provide dates covered by CPARs:

*****FOLLOWING SECTIONS COMPLETED BY CONTRACTING AGENCY*****

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or Agency Name

B. Customer or Agency Description

C. Description of Service(s) provided (Provide details on type of work, locations worked, and organizations serviced, to include Department of Defense, Government, or commercial work)

SECTION 3: EVALUATOR IDENTIFICATION

A. Name _________________________________________ B. Title

C. Phone/Fax D. E-mail

E. Years worked on Subject Contract

SECTION 4: EVALUATION

Please indicate your satisfaction with the Contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

Please provide detailed narrative comments to support your ratings. At a minimum, please discuss each response for which you indicated E (Exceptional), M (Marginal) or U (Unsatisfactory) in response to the questions below (use additional sheets, if necessary).

Ability of Contractor to: provide accurate deliverables/reports; meet service specifications of the contract; provide timely proposals; respond to short notice requirements; provide and adhere to quality control/management plan (when required)

Explanation:

Ability of Contractor to: provide accurate contract costs/estimates; track and control costs; meet and perform within negotiated costs; provide current, accurate and complete invoices/billing; submit cost reporting information in a timely manner

Explanation:

Ability of Contractor to: maintain effective relationship between key Contractor personnel and key Government personnel; manage, resolve problems and respond to and/or integrate changes in mission-related requirements

Explanation:

Ability of Contractor to: attract, recruit, hire, train and retain qualified management and technical personnel to accomplish mission requirements; manage subcontractors to include identification and resolution of subcontractor problems; ensure continuation of services during personnel absences or vacancies; replace/fill vacancies within timeframe specified; maintain training/certification currency

Explanation:

SECTION 5: NARRATIVE SUMMARY

A. Was this contract partially or completely terminated for default or convenience or are there any pending terminations? (Place an “X” by all that apply.)

Yes No Default Convenience Pending Terminations

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

B. Would you have any reservations about having this Contractor perform again on one of your critical and demanding programs?

Evaluator’s Signature Date

UPON COMPLETION PLEASE SUBMIT TO:

Questionnaires must be received by TBD to be evaluated. Electronic questionnaires are accepted.