ATTACHMENT_D_Past_Performance_Questionaire.pdf

Form PPQ-0 (4/6/11)

NAVFAC PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0) CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information:

Firm Name:

Address:

Phone Number:

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 prime (Name/Phone #):

3. Contract Information

Contract Number:

Delivery/Task Order Number (if applicable):

Title:

Location:

Award Date (mm/dd/yy):

Completion Date (mm/dd/yy):

Award Amount:

Final Price:

4. Project Description:

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:

8. Client’s Signature:

NOTE: THE CONTRACTOR MAY COLLECT AND RETAIN COMPLETED QUESTIONNAIRES FROM

CLIENTS FOR SUBMITTAL TO THE GOVERNMENT. AFTER COMPLETION OF THIS FORM, THIS

FORM MAY BE DUPLICATED BY THE CONTRACTOR. THE GOVERNMENT RESERVES THE RIGHT TO

VERIFY ANY AND ALL INFORMATION.

TO BE COMPLETED BY CLIENT

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

E (EXCELLENT) – Performance meets contractual requirements and exceeds the Client’s/Government’s expectations.

The contractual performance of the element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

V (VERY GOOD) – Performance meets contractual requirements and exceeds some of the Client’s/Government’s expectations. The contractual performance of the element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S (SATISFACTORY) – Performance meets contractual requirements. The contractual performance of the element contains some minor problems for which corrective action taken by the contractor appear or were satisfactory.

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

U (UNSATISFACTORY) – Performance does not meet most contractual requirements and/or recovery is not likely in a timely manner. The contractual performance of the element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N (NOT APPLICABLE) – No past performance record is identifiable or the element is not applicable to this project.

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. Ability to meet quality standards specified for technical performance. E V S M U N

2. Compliance with contractual terms and conditions. E V S M U N

3. Compliance with contract delivery/completion schedules including any significant intermediate milestones. E V S M U N

4. Quality/integrity of technical data/report preparation efforts. E V S M U N

5. Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements. E V S M U N

6. Effectiveness of overall contract management (including ability to effectively lead, manage and control the program). E V S M U N

7. Effectiveness of on-site management, including management of subcontractors? E V S M U N

8. Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports).

E V S M U N

9. Timeliness/effectiveness of contract problem resolution without extensive customer guidance. E V S M U N

10. Ability to successfully respond to emergency and/or surge situations. E V S M U N

11. Effectiveness of material management. E V S M U N

12. Effectiveness of acquisition management. E V S M U N

13. Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client.

E V S M U N

14. Contractor’s management of their safety program. E V S M U N

15. Responsiveness regarding safety issues. E V S M U N

16. If this was a cost type contract, compliance with established budgets and avoidance of significant and/or unexplained variances (underruns or overruns).

E V S M U N

17. If this is/was a Government cost type contract, the Contractor’s timeliness in submitting monthly invoices with appropriate back-up documentation and monthly status reports/budget variance reports.

E V S M U N

18. If this is/was a Government cost type contract, the Contractor’s accuracy regarding monthly invoices with appropriate back-up documentation and monthly status reports/budget variance reports.

E V S M U N

19. Ability to hire/apply a qualified workforce to this effort. E V S M U N

20. Ability to retain a qualified workforce on this effort E V S M U N

21. If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

Yes No

22. Have there been any indications that the contractor has had any financial problem? If yes, please explain below. Yes No

23. In summary, provide an overall rating for the work performed by this contractor. E V S M U N

Any additional comments related to the contractor’s performance: