Form 5 - PPQ - Fillable.pdf

FORM 5: PAST /PRESENT PERFORMANCE REFERENCE INSTRUCTIONS

Reference Information Table: OFFEROR should complete the Reference Information Table BEFORE sending this questionnaire to the customers to ensure the accuracy of the information being provided. Send the completed Reference Information Table and blank questionnaire to each customer with a cover letter that 1) authorizes the selected customers to discuss the offeror’ s performance under the applicable contract with the contracting officer;

2) requests the customer complete the questionnaire; and 3) instructs the customer to return the completed questionnaire by email to: wyv2@cdc.gov. Submit a copy of the customer’s cover letter with your business proposal to ensure receipt of questionnaires’ responses.

Past /Present Performance Questionnaire: Customer /reference responses will be rated using the following scale:

Rating Rating Code Description

Unsatisfactory P/U Does not meet minimum acceptable standards in one or more areas; remedial action required in one or more areas; deficiencies in one or more areas which adversely affect overall performance.

Satisfactory S Meets or slightly exceeds minimum acceptable standards; adequate results;

reportable deficiencies with identifiable, but not substantial, effects on overall performance.

Good G Effective performance; fully responsive to contract requirements; reportable deficiencies, but with little identifiable effect on overall performance.

Very Good VG

Very effective performance; fully responsive to contract requirements;

contract requirements accomplished in a timely, efficient, and economical manner for the most part; only minor deficiencies with minimal effect on overall performance.

Excellent E Of exceptional merit; exemplary performance in a timely, efficient, and economical manner; very minor (if any) deficiencies with no adverse effect on overall performance.

Neutral N No record of relevant past performance or past performance information is not available mailto:oadsbaaprojects@cdc.gov

Reference Information Table (to be completed by the Offeror): Send the completed Table and blank questionnaire to each customer with a cover letter that 1) authorizes the selected customers to discuss the offeror’s performance under the applicable contract with the contracting officer; 2) requests the customer complete the questionnaire; and

3) instructs the customer to return the completed questionnaire by email to: wyv2@cdc.gov

Offeror /Organization Name

BAA Number

Reference Business Name

Reference Business Address

Point of Contact

Phone number

E-mail address

Contract Number

Dollar Value

Period of Performance

Description of Services Performed

Explain any problems and resolutions mailto:oadsbaaprojects@cdc.gov

Past /Present Performance Questionnaire: By receipt of this request, Offeror authorizes the selected customers to discuss their performance under the applicable contract with the contracting officer. Please return the completed questionnaire by email to: wyv2@cdc.gov

1 How would you rate the contractor’s compliance with the delivery schedule / performance milestones?

Rating

Comments

2 How would you rate the contractor’s business practices (e.g. maintaining a positive working relationship, business ethics, timely and effectively resolution of any problems etc.)?

Rating Comments

3 How would you rate the contractor’s record of conforming to contract requirements and to standards of good workmanship/quality of the product or service?

Rating Comments

4 How would you rate the contractor’s overall compliance with the terms and conditions of your purchase order /contract?

Rating Comments

5 How would you rate the contractor’s history of reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer?

Rating Comments

6 How would you rate the contractor’s overall performance?

Rating Comments

Would you purchase services from this contractor again?

Yes

No Please provide any additional comments applicable to the contractor’s past performance

Reference Businesss Name Reference Name Signature mailto:oadsbaaprojects@cdc.gov