Atch 5, PPQ.doc

Attachment 5

FA5613-20-R-0003

Past Performance Questionnaire (PPQ) This acquisition is for Preventive Maintenance, Safety Inspections and Repair of Hoists in the Kaiserslautern Military Community.

A.

GENERAL INFORMATION: Please correct any information below known to be inaccurate:

Contractor’s Name: ____________________ Address:

Telephone Number: ____________________

Email Address:

Point of Contact:

Project Title or Brief Description of Work*:

Contract Number*:

Contract Amount:

Contract Period or Dates of Performance*:

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

To be completed by the respondent and returned directly to the contracting office.

* Note: If offeror holds or has held other contracts with your agency/organization in the last 5 years, please complete separate evaluation forms for those contracts as well.

B.

RATER INFORMATION:

Name of Rater:

Title:

Address:

Phone Number:

Email Address:

C. RETURN COMPLETED SURVEY FORM WITHIN 4 WORKING DAYS AFTER RECEIPT TO:

Jutta Keller/Contracting Specialist Andrew Peterson /Contracting Officer

700 CONS/PKA

and

700 CONS/PKA

jutta.keller..de@us.af.mil andrew.peterson.4.@us.af.mil

+49-631-536-8444, DSN 489-8444

+49-631-536- 6598 or DSN 489-6598

CONTRACTOR’S NAME:

CONTRACT NUMBER:

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

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

REMARKS/COMMENTS: