15._FA5706-15-R-0005_Atch_5_-_PPQ.doc

Source Selection Information -- See FAR 2.101 and 3.104

FA5706-15-R-0005

Attachment 5

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

INSTRUCTIONS FOR COMPLETING THE PPQ

1. This Acquisition is for the Multiple Award Construction Contract (MACC) program consisting of a broad range of design-build, maintenance, alteration, repair, renovation, and minor construction projects affecting real property throughout Al Dhafra Air Base (ADAB).

2. As part of the source selection process, this questionnaire is provided to assist the 380th Expeditionary Contracting Squadron in the past performance evaluation of offerors pertaining to the competitive acquisition for the MACC throughout ADAB that will result in the award of a federal contract. Therefore, it is important that your information be as factual, accurate and as complete as possible to preclude the need for follow-up queries by the evaluators. In an effort to expedite receipt of the requested information, the Contracting Officer respectfully requests that you DO NOT MAIL hard copies. Instead, please e-mail the completed questionnaire(s) to 380 ECONS at 380ECONS.Construction@adab.afcent.af.mil, no later than 26 March 2015. Please complete the attached questionnaire using the following guidance.

2. Indicate, based on the adjectives below, the contractor’s performance on the identified program. Assessments should reflect only contractor liable performance. PLEASE PROVIDE A NARRATIVE EXPLANATION FOR ANY RATINGS OF E, VG, M or U.

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

Performance meets contractual requirements and exceeds some to your organization’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were 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 appear or were satisfactory.

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

3. Include the contractor’s name and the contract number for which the past performance information applies on each page of the questionnaire form to ensure there is no mix up in information among contracts surveyed for respective prime/sub-contractors, etc.

I. CONTRACT AND PROGRAM IDENTIFICATION

A.

GENERAL INFORMATION:

Contractor’s Name:

Address:

Telephone Number:

Email Address:

Point of Contact:

CAGE Code:

Project Title or Brief Description of Work*

Contract Number:

Contract Amount (USD):

Contract Period or Dates of Performance*:

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

To be completed by the rater 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:

Primary

Alternate Name of Rater:

Name of Rater:

Title:

Title:

Agency:

Agency:

Office Symbol:

Office Symbol:

Telephone Number:

Telephone Number:

Email Address:

Email Address:

Note: Once the PPQ is complete, it is considered to be Source Selection Information.

II. PROGRAM RELEVANCY

A. To help determine program relevancy, please indicate below the work the contractor has or is performing under this contract by marking the applicable box with X or √ or N/A.

Electrical

A/E Design work

Painting

Roofing

Flooring

HVAC

Paving/Concrete

Sewer/Waterline

Civil

Mechanical

Structural

B. Contract type (ex: FFP, Cost, T&M, etc.):

C. Was this an indefinite-delivery indefinite-quantity type contract with multiple task orders?

Yes

No

D. Was it a design-build contract?

Yes

No

E. Geographic description of work under this contract, i.e. local, nationwide, worldwide, or other commands:

III. PAST PERFORMANCE EVALUATION

Please mark the appropriate column with “X” or “√” using the definitions matrix set forth in the instructions, and provide a narrative explanation for ratings of E, VG, M or U.

If yes, explain outcome in “remarks.”

If not, explain in “remarks.”

Remarks: ____________________________________________________________________________________

RETURN COMPLETED QUESTIONNAIRES DIRECTLY TO

THE CONTRACTING OFFICER (see POCs at paragraph 2)

**DO NOT RETURN TO THE CONTRACTOR**

THANK YOU FOR YOUR PROMPT RESPONSE AND ASSISTANCE!

CONTRACTOR’S NAME:

CONTRACT NUMBER:

For Official Use Only

Source Selection Information -- See FAR 2.101 and 3.104