N3943017T19100001Past_Performance_Questionnaire.pdf

EXHIBT A

NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Firm Name: CAGE Code:

Address: DUNs Number:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture

Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work High Med Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name:

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: NAVFAC REQUESTS THAT THE CLIENT COMPLETES THIS

QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE

OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO NAVFAC

WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR

FUTURE SUBMISSION ON NAVFAC SOLICITATIONS. CLIENTS ARE HIGHLY

ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR.

HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO NAVFAC.

PLEASE CONTACT THE OFFEROR FOR NAVFAC POC INFORMATION. THE

GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL

INFORMATION ON THIS FORM.