Past_Performance_Questionnaire.pdf

FOR OFFICIAL USE ONLY

SOURCE SELECTION SENSITIVE INFORMATION

Source Selection Information -- See FAR 2.101 and 3.104.

PAST PERFORMANCE QUESTIONNAIRE

1. The Form PPQ shall be utilized for all evaluations that require a Past Performance Questionnaire.

2. Solicitations

Solicitation Submittal Requirements: IF A COMPLETED CPARS EVALUATION IS AVAILABLE, IT SHALL BE REVIEWED WITH THE PROPOSAL. IF THERE IS NOT A COMPLETED CPARS EVALUATION, the PPQ included in the solicitation is provided for the offeror or its team members to submit to the client for each project the offeror includes in its proposal for Factor 1, Recent or Current Past Performance. AN OFFEROR

SHALL NOT SUBMIT A PPQ WHEN A COMPLETED RELEVANT CPARS IS AVAILABLE.

IF A RELEVANT CPARS EVALUATION IS NOT AVAILABLE, ensure correct phone numbers and email addresses are provided for the client point of contact. Completed PPQs should be submitted with your proposal. If the offeror is unable to obtain a completed PPQ from a client for a project(s) before proposal closing date, the offeror should complete and submit with the proposal the first page of the PPQ (Attachment 4), which will provide contract and client information for the respective project(s). Offerors should follow- up with clients/references to ensure timely submittal of questionnaires. If the client requests, questionnaires may be submitted directly to the Government's point of contact, Erin Doering, via email at Erin.Doering@ihs.gov prior to proposal closing date. Offerors shall not incorporate by reference into their proposal PPQs or CPARS previously submitted for other RFPs. However, this does not preclude the Government from utilizing previously submitted PPQ information in the past performance evaluation.

This form will be made accessible on the SAM website as a separate attachment.

Source Selection Information -- See FAR 2.101 and 3.104.

PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Firm Name: CAGE Code:

Address: SAM UEI No.:

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

Medium

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:

PSC/NAICS Code associated with contract:

Source Selection Information -- See FAR 2.101 and 3.104.

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 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.

Source Selection Information -- See FAR 2.101 and 3.104.

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/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner.

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/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been no significant weaknesses identified.

(S) Satisfactory

Performance meets minimum 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.

A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract.

There should have been NO significant weaknesses identified.

Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

(M) Marginal

Performance does not meet some contractual requirements. The contractual performance of the element or sub-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.

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/ Owner.

Source Selection Information -- See FAR 2.101 and 3.104.

RATING DEFINITION NOTE

(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 serious problem(s) for which the contractor's corrective actions appear or were ineffective.

An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating.

(N) Not Applicable

No information or did not apply to your contract

Rating will be neither positive nor negative.

Source Selection Information -- See FAR 2.101 and 3.104.

Contractor Information (Firm Name):

Client Information (Name):

TO BE COMPLETED BY THE 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

Source Selection Information -- See FAR 2.101 and 3.104.

Contractor Information (Firm Name):

Client Information (Name):

f) Ability to simultaneously manage multiple projects with multiple disciplines

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.

E VG S M U N

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.

E VG S M U N

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

E VG S M U N

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

Source Selection Information -- See FAR 2.101 and 3.104.

Contractor Information (Firm Name):

Client Information (Name):

c) Would you hire or work with this firm again? (If no, please explain below)

Y N

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).