Optional Past Performance Questionnaire.docx
DOCX document 30 KB Posted
- Attached to
- Rosebud Lift Station Construction
- Solicitation number
- 75H70126R00018
About this file
This is an Optional Past Performance Questionnaire (PPQ) form designed for Solicitation 75H70126R00018 (Rosebud Lift Station Construction) issued by the Indian Health Service under the Department of Health and Human Services. The form is structured in two sections: contractor information to be completed by the bidding firm and client evaluation information to be completed by the contracting officer or government representative.
The contractor section requests standard business information including firm name, CAGE code, UEI, and point of contact details, along with contract specifics such as contract type (firm fixed price, cost reimbursement, or other), original and final contract prices, delivery dates, and project description including complexity level and relevance to the current solicitation. The client evaluation section, to be completed by the government, assesses contractor performance across seven major categories: Quality (technical data preparation, quality standards compliance, problem resolution, quality control effectiveness); Schedule/Timeliness (delivery schedule compliance and resource utilization); Customer Satisfaction (end-user satisfaction, cooperation, and overall satisfaction); Management/Personnel/Labor (on-site management, workforce qualification, government property control, expertise, small business utilization, multi-project management, and change management); Cost/Financial Management (price compliance, cost reduction innovations, invoice timeliness for cost-type contracts, accounting system adequacy, termination history, and financial stability); Safety/Security (safety plan adherence and security compliance); and General factors (emergency response capability, contractual compliance, and overall performance rating). Evaluators rate performance using five adjective scales—Exceptional (E), Very Good (VG), Satisfactory (S), Marginal (M), Unsatisfactory (U)—plus Not Applicable (N)—with detailed definitions provided for each rating level. The form notes that clients are encouraged to submit completed questionnaires directly to offerors, though submission to IHS is permitted, and the government reserves the right to verify all information provided.
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| J06 IHS IEE Representation Form.pdf | ||
| J04 Wage Det SD20260018 2Jan2026.pdf | ||
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| J01 SOW Rosebud Lift Station Construction.docx | DOCX document | |
| J05 Self Performed Calculation Sheet.docx | DOCX document | |
| J03 Tech Specs RLSC.pdf | ||
| J08 Release of Claims.docx | DOCX document | |
| J02 Plans RLSC.pdf | ||
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Text version
Optional Attachment Past Performance Questionnaire (PPQ) Form PPQ
Volume I – Factor 2 – Past Performance
FOR OFFICIAL USE ONLY, SOURCE SELECTION INFORMATION (FAR 3.104)
Response to Solicitation 75H70126R00018
(Cover page not required in submission)
SOLICITATION 75H70126R00018
COMPANY EXPERIENCE FORM (PAST PERFORMANCE)
PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)
CONTRACT INFORMATION (Contractor to complete Blocks 1-4)
| 1. Contractor Information | |
| Firm Name: | CAGE Code: |
| Address: | UEI: |
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: IHS DES REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO IHS WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON IHS SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO IHS. PLEASE CONTACT THE OFFEROR FOR IHS POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.
ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT
YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE
RATING DEFINITION NOTE
| (E) Exceptional |
| Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. |
| To justify an Exceptional rating, identify multiple significant events and state how they were of benefit to the Government. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified. |
| (VG) Very Good |
| Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being evaluated was accomplished with some minor problems for which corrective actions taken by the contractor were effective. |
| To justify a Very Good rating, identify a significant event and state how it was a benefit to the Government. There should have been no significant weaknesses identified. |
| (S) Satisfactory |
| Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory. |
| To justify a Satisfactory rating, there should have been only minor problems, or major problems the contractor recovered from without impact to the contract/order. There should have been NO significant weaknesses identified. A fundamental principle of assigning ratings is that contractors will not be evaluated with a rating lower than Satisfactory solely for not performing beyond the requirements of the contract/order. |
| (M) Marginal |
| Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being evaluated 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. |
| To justify Marginal performance, identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the Government. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter). |
| (U) Unsatisfactory |
| Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective. |
| To justify an Unsatisfactory rating, identify multiple significant events in each category that the contractor had trouble overcoming and state how it impacted the Government. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating. An Unsatisfactory rating should be supported by referencing the management tools used to notify the contractor of the contractual deficiencies (e.g., management, quality, safety, or environmental deficiency reports, or letters). |
| (N) Not Applicable |
| No information or did not apply to your contract |
| Rating will be neither positive nor negative. |
TO BE COMPLETED BY CLIENT
PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS
YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.
1. QUALITY:
| a) Quality of technical data/report preparation efforts |
| E VG S M U N |
| b) Ability to meet quality standards specified for technical performance |
| E VG S M U N |
| c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance |
| E VG S M U N |
| d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance) |
| E VG S M U N |
2. SCHEDULE/TIMELINESS OF PERFORMANCE:
| a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below) |
| E VG S M U N |
| b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract |
| E VG S M U N |
3. CUSTOMER SATISFACTION:
| a) To what extent were the end users satisfied with the project? |
| E VG S M U N |
| b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication) |
| E VG S M U N |
| c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer? |
| E VG S M U N |
| d) Overall customer satisfaction |
| E VG S M U N |
4. MANAGEMENT/ PERSONNEL/LABOR
| a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force? |
| E VG S M U N |
| b) Ability to hire, apply, and retain a qualified workforce to this effort |
| E VG S M U N |
| c) Government Property Control |
| E VG S M U N |
| d) Knowledge/expertise demonstrated by contractor personnel |
| E VG S M U N |
| e) Utilization of Small Business concerns |
| E VG S M U N |
| f) Ability to simultaneously manage multiple projects with multiple disciplines |
| E VG S M U N |
| g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes |
| E VG S M U N |
| h) Effectiveness of overall management (including ability to effectively lead, manage and control the program) |
| E VG S M U N |
5. COST/FINANCIAL MANAGEMENT
| a) Ability to meet the terms and conditions within the contractually agreed price(s)? |
| E VG S M U N |
| b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client |
| E VG S M U N |
| c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns) |
| E VG S M U N |
| d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section. |
| Yes No |
| e) 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 |
| f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below. |
| Yes No |
6. SAFETY/SECURITY
| a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.) |
| E VG S M U N |
| b) Contractor complied with all security requirements for the project and personnel security requirements. |
| E VG S M U N |
7. GENERAL
| a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues). |
| E VG S M U N |
| b) Compliance with contractual terms/provisions (explain if specific issues) |
| E VG S M U N |
| c) Would you hire or work with this firm again? (If no, please explain below) |
| Yes No |
| d) In summary, provide an overall rating for the work performed by this contractor. |
| E VG S M U N |
Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):
File details come from the government source that posted it. Updated .