Attachment 4- Past Performance Questionnaire.docx

PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

Offeror – Complete Part I and forward onto past/present customers of yours for them (Program Managers, Contracting Officer Representatives, etc.) to complete, sign, and return to the sender and submit as part of your offer.

Respondents – Please provide your candid responses. The information that you provide will be used in the awarding of federal contracts. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators. If you do not have knowledge of or experience with the company in question, please forward this Questionnaire to the person who does.

Thank you.

PART I. (To be completed by the Offeror)

A. Contract Identification

Contractor/Company Name/Division:

DUNS Number/CAGE Code:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Contract Dollar Value:

Prime Contractor Name (if different from the contractor name cited above) Contract Award Date::

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items Purchased:

Labor categories (including brief description of labor category) and number of workers per labor category:

B. Identification of Offeror’s Representative Name:

Title:

Date:

Telephone Number:

Address:

E-mail Address:

PART II. EVALUATION (TO BE COMPLETED BY POINT OF CONTACT – RESPONDENT)

A. Respondent Identification. Please provide the following information: Organization:

Name:

Title:

Telephone Number Address:

E-mail Address:

Is the information the contractor provided on the proceeding page, page 1, PART I., A. Correct?

Identification accurate (select Yes or No)? Yes No If not accurate, describe corrections?

Adjective ratings and definitions to be used to best reflect your evaluation of the contractor's performance.

minor problems for which corrective actions taken by the contractor were highly effective.

were effective.

performance of the element or sub-element may have contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

a) Assess the contractor's ability to staff and maintain staffing at or above what was required. Please elaborate on rating in box below.

b) Assess the contractor’s ability to understand/comply with contract objectives and desired outcomes. Please elaborate on rating in box below.

a) How well did the contractor meet deadlines in the transition plan, if applicable? Assess the timeliness of the Contractor in filling required positions. Please elaborate on rating in box below.

a) How well did the contractor manage key personnel and/or staff? Assess the contractor’s performance in selecting, retaining, supporting, and replacing, when necessary, qualified personnel. Please elaborate on rating below.

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones?

b) Rate the Contractor's use of available resources to accomplish tasks identified in the contract.

Please elaborate on the two schedule/timeliness of performance for the above two ratings.

a) To what extent were the end users satisfied with the effort?

b) Overall customer satisfaction?

a) Ability to hire, apply, and retain a qualified workforce to this effort?

b) Knowledge/expertise demonstrated by contractor personnel?

c) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes?

d) Effectiveness of overall management (including ability to effectively lead, manage and control the program)?

e) Effectively transition personnel and operations when taking over from the incumbent contractor?

Please elaborate on the assessed ratings from the Management/Personnel/Labor section

a) Ability to meet the terms and conditions within the contractually agreed price(s)?

Knowing what you know now would you select this offeror for your above-described effort (Select one)? Yes No

Additional comments (Please insert additional comments if you have any if no additional comments enter – NONE.

PART III. RESPONDENT CERTIFICATION

I, , certify that I completed this questionnaire accurately to (printed name) the best of my knowledge and belief.

(signature) (Date)

[CAC Electronic Signatures are Acceptable]

After you complete and sign this PPQ return it back to the offeror for offeror to include in its proposal to the DHA.

If you have any questions or concerns, you can contact the Government Contract Specialist at mallory.m.vasquez.civ@health.mil and Government Contracting Officer at stephani.n.preusser.civ@health.mil.

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