Attachment 3 NAVFAC Past Perf FORM PPQ 0.pdf

NAVFAC / USACE Past Performance Questionnaire (PPQ) Form PPQ -0 (9/30/11)

APPENDIX 15-1, Page 4 of 7 01 November 2014

UAI VERSION 3

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/USACE requests that the client completes this questionnaire and submits directly back to the offeror.

The offeror will submit the completed questionnaire to USACE with their proposal, and may duplicate this questionnaire for future submission on USACE solicitations. Clients are highly encouraged to submit questionnaires directly to the offeror. However, questionnaires may be submitted directly to USACE. Please contact the offeror for USACE POC information. The Government reserves the right to verify any and all information on this form.

• Did this project involve the renovation or replacement of a comparably sized roof (area at least 15,000 square feet)? Provide approximate square footage of roof that was renovated or replaced.

• Did this project involve a roofing system similar to that being specified (i.e. an inverted roof system with paver ballast)? Identify roofing system manufacturer and product line name.

• Did this project involve similar complexity with limited access to the project site, requiring scaffolding and craning of material to the area of work? Describe use of scaffolding and crane for this project.

• Was this project performed in an occupied and functioning office or medical building? Identify building type for this project.

• Did this project involve roofing related disciplines - architectural, civil, structural, and electrical? Describe the architectural/civil/structural/electrical work involved with this project.

• Was the total project cost at award of the construction contract(s) at least $1 million? Provide total project cost at award of contract.

• Did this project involve “Irma' & `Torch Applied Systems”? Provide roofing system manufacturer and product line name.