J-L1_Attachment-_Past_Performance_Questionnaire.pdf

ATTACHMENT J-L1: Past Performance Questionnaire (PPQ)

HQ0034-15-R-0136

Dated: 22 February 2016

Pages: 4

PAST PERFORMANCE QUESTIONNAIRE

SOURCE SELECTION SENSITIVE

See FAR 2.101 and 3.104

TO: FACSIMILE:

PHONE: EMAIL:_________________________

Information Request

***NOTE: Offerors SHALL NOT complete this form on behalf of the reference. All completed questionnaires shall be returned directly to the Government and not to the offeror. If a completed questionnaire is submitted by the Offeror directly to the Government, the Questionnaire will NOT be evaluated. Thank you for your attention to this matter.

Washington Headquarters Services is currently in the process of soliciting offers for a contract for the purchase of

Arc Flash Uniforms. [CONTRACTOR NAME] provided your name and organization as a reference regarding

[CONTRACT DESCRIPTION past performance under

(CONTRACT NO.]. Specifically, we are looking for past performance information in the following areas:

a.) Quality of Service b.) Timeliness or Scheduling of Service c.) Business Relations/Customer Satisfaction d.) Key Personnel and Staffing (Including Subcontractors)

In order for our team to compile its evaluation, we request that you complete the attached survey form and email it, and any other pertinent information not later than 29 April 2016 at or before 11am Eastern Time (ET) to

Samia.c.bingham.civ@mail.mil

Washington Headquarters Services, Acquisition Directorate Attn: Samia Bingham

1225 South Clark Street

Suite 1202

Arlington, VA 22202

****TO BE COMPLETED BY THE REFERENCE ONLY****

Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings:

Exceptional (E), Very Good (VG), Satisfactory (S), Marginal (M), or Unsatisfactory (U). See next page for definition of ratings.

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: _____________________________________________________________

B. Cage Code: _______________________________________

C. Contract number: ___________________________________________________________________________

D. Contract type (e.g. Fixed price, Cost reimbursement): ______________________________________________

E. Was the referenced contractor the prime contractor on this contract? Yes____ No____

Dated: 22 February 2016

Pages: 4

F. Type of Supply or Service: _____________________________

G. Was this a competitive contract? Yes _____ No _____

H. Period of performance: _______________________________________________________________________

I. Place of performance: _______________________________________________________________________

J. Initial Contract price: $_______________________________________________________________________

K. Current/final contract price: $__________________________________________________________________

L. Current status of contract (choose one)

[ ] Ongoing [ ] Complete [ ] Terminated for Convenience [ ] Terminated for Default [ ] Other (explain)

M. Reason(s) for differences between initial contract price and final contract price: __________________________

N. Description of commisioning services provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name:

B. Customer or agency description (if applicable):

SECTION 3: REVIEWER IDENTIFICATION

A. Reviewer's name:

B. Reviewer's title:

C. Reviewer's phone/email address:

Number of months the reviewer worked on subject contract: _____________________

SECTION 4: EVALUATION

Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings: Exceptional (E), Very Good (VG), Satisfactory (S), Marginal (M), Neutral (N) or Unsatisfactory (U). See next page for definition of ratings.

Dated: 22 February 2016

Pages: 4

1. Please provide an overall rating of the contractor’s past performance for the referenced contract/delivery order.

2. Please describe the quality of the work:

a. Conformance to contract requirements, accuracy of supply order and quality of uniforms..

b. Business Relations/Customer Satisfaction

3. Provide a detailed description of the Commissioning Services Project.

4. Did the contractor complete the project within schedule? Timeliness of performance, met interim milestones, reliable, responsive to technical and contractual direction as to scheduling? If the answer is no, please explain the circumstances for delay.

5. If there were change orders (work that is added to or deleted from the original scope of work of a contract), please describe the contractor’s ability to successfully perform the contract requirements with the change in scope.

6. Please describe the Timeliness or Scheduling of Services/Deliveries, Emergencies, and/or Unforeseen

Requests?

Dated: 22 February 2016

Pages: 4

7. Please rate the level of effective management, prompt notification of problems, reasonable/cooperative behavior, proactive, timely award and management of subcontracts, effective small business/small disadvantaged business. Describe any problems.

8. Would you hire this contractor to provide supplies/services for your organization in the future? Please provide comments using additional pages, if desired.

Reviewer’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Via Email to:

Samia Bingham

Contract Specialist

Washington Headquarters Services

Acquisition Directorate (WHS/AD)

EFCD/O&M-Pentagon

1225 South Clark St.

Arlington, VA 22202

Phone:703-545-1578 samia.c.bingham.civ@mail.mil mailto:samia.c.bingham.civ@mail.mil