Attachment 4 - Past Performance Information Form.docx

SOURCE SELECTION SENSITIVE IAW FAR 3.104 WHEN FILLED IN

FA452821R0006

Attachment 4

PAST AND PRESENT PERFORMANCE INFORMATION FORM (PPIF)

A. GENERAL INFORMATION:

Contractor’s Name: __________________ Telephone : __________________________ Address: __________________________ Fax Number: _________________________ __________________________ Point of Contact: ______________________

Submitting Survey as Prime or Sub-Contractor (please circle one) If submitting as Sub-Contractor, Prime Contractors Name:___________________________ Address: __________________________ Fax Number: _________________________ __________________________ Point of Contact: ______________________

Project Title and Detailed Description of Work: ______________________________________________

Contract Number Provided by Offeror: ___________________ Dollar Amount: ________

Contract Period or Dates of Performance Provided by Offeror: ______________________

Contractor performed as the Prime Contractor Sub-Contractor Key Personnel.

B. RESPONDENT INFORMATION:

Name and Title of Evaluator: ____________________________

Company Name: ______________________________________

C. SEND COMPLETED SURVEY FORM TO:

5 CONS/LGCA, 165 Missile Avenue, Minot AFB, ND 58705 ATTN; Carlan Taft EMAIL: carlan.taft@us.af.mil

DUTY PHONE: (701) 723-7674

D. PERFORMANCE INFORMATION: Choose the appropriate letter on the scale (E, G, S, M, U, and N) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF M or U.

Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

Performance meets contractual requirements with some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor were satisfactory.

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Performance was not observed or not applicable to the current effort being reported against.

CONTRACTOR’S NAME: _______________ CONTRACT NUMBER: _______________

Note: Include this information on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective primes/subs, etc.

Place an “X” in the appropriate column using the definitions matrix above.

YES/NO

YES/NO

CONTRACTOR’S NAME: ___________________ CONTRACT NUMBER ______________

Remarks:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________