PPQ - 27Q0075 - Vendor Name.docx
DOCX document 50 KB Posted
- Solicitation number
- 36C25027Q0075
About this file
This is a Past Performance Questionnaire (PPQ) template for the solicitation of Facility Scrap and Recycling Services at the Northeast Ohio VA Healthcare System's Louis Stokes VA Medical Center. The questionnaire is designed to collect information about contractors' relevant past performance on similar projects and must be completed by vendors responding to Solicitation #36C25027Q0075. Responses are due to Josh Kovar at Joshua.Kovar@VA.gov by November 23, 2026, at 1:30 PM EST, with the email subject line formatted as "27Q0075 - PPQ, [Name of Offeror]."
The PPQ requires offerors to complete Sections 1-4 with company information, contract details, project descriptions, and relevancy explanations, then forward the form to a reference customer who completes the remaining sections. References evaluate performance across eight rating categories: Quality, Schedule/Timeliness, Customer Satisfaction, Management/Personnel/Labor, Cost/Financial Management, Safety/Security, General, and Summary. Each category uses a six-point rating scale (Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory, Not Applicable). The questionnaire also requests identification of three reference contacts (including the Contracting Officer and COR), contract pricing information (original and final amounts), contract type (Firm Fixed Price, Cost Reimbursement, or Other), and specific information about project scope, complexity, and any key personnel proposed on the current solicitation. References must confirm the accuracy of the work description and provide narrative comments on contractor strengths, weaknesses, and overall performance indicators, including whether they would hire or work with the contractor again.
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| File | Type | Posted |
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| 36C25027Q0075_1.pdf | ||
| Price-Cost_Schedule - 27Q0075 - V1.xlsx | XLSX spreadsheet | |
| 36C25027Q0075.docx | DOCX document |
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Solicitation #: 36C25027Q0075 Northeast Ohio VA Healthcare System – Facility Scrap and Recycling Services Due Date: November 23, 2026 by 1:30 PM EST Send To: Josh Kovar - Joshua.Kovar@VA.gov
PAST PERFORMANCE QUESTIONNAIRE
This questionnaire requests information about work your company has previously performed. Please complete Sections 1 through 4, then forward the form to your reference (the customer for whom the work was performed) to complete the remaining sections.
1. CONTRACTOR / OFFEROR INFORMATION
Past Performance Reference No. (1-3): Click or tap here to enter text.
Offeror Name: Click or tap here to enter text.
Address: Click or tap here to enter text.
Phone Number: Click or tap here to enter text.
SAM UEI (Unique Entity ID, from SAM.gov): Click or tap here to enter text.
Contact Name: Click or tap here to enter text.
Email Address: Click or tap here to enter text.
Contact Phone Number: Click or tap here to enter text.
2. GENERAL WORK INFORMATION
Work performed as: ☐ Offering Entity (Prime Contractor) ☐ Predecessor Company ☐ Key Personnel Percent (%) of project work performed by the Offering Entity (Prime Contractor), Predecessor Company, or Key Personnel: Click or tap here to enter text.
List of Major Subcontractor(s) and Role(s): Click or tap here to enter text.
3. CONTRACT INFORMATION
Contract Number: Click or tap here to enter text.
Contractor Name as Reflected on the Referenced Contract: Click or tap here to enter text.
Contractor SAM UEI as Reflected on the Referenced Contract: Click or tap here to enter text.
Agency/Customer: Click or tap here to enter text.
Delivery/Task Order Number (if applicable): Click or tap here to enter text.
Contract Type: ☐ Firm Fixed Price ☐ Cost Reimbursement ☐ Other (please explain) Contract Title: Click or tap here to enter text.
Contract Location: Click or tap here to enter text.
Award Date (mm/dd/yy): Click or tap here to enter text.
Completion Date (mm/dd/yy): Click or tap here to enter text.
Awardee Ongoing Services: Click or tap here to enter text.
Original Contract Price (Award Amount): Click or tap here to enter text.
Final Contract Price (to include all modifications, if applicable): Click or tap here to enter text.
REFERENCE INFORMATION
Please provide contact information for up to three individuals who can speak to the performance described in this questionnaire.
Past Performance Questionnaire Reference
| Name & Title: |
| Click or tap here to enter text. |
| Phone No.: |
| Click or tap here to enter text. |
| Email: |
| Click or tap here to enter text. |
| Address: |
| Click or tap here to enter text. |
Contracting Officer (CO), or Individual Responsible for Signing the Contract
| Name & Title: |
| Click or tap here to enter text. |
| Phone No.: |
| Click or tap here to enter text. |
| Email: |
| Click or tap here to enter text. |
| Address: |
| Click or tap here to enter text. |
Program Point of Contact / CO's Technical Representative (COR) / Supervisor
| Name & Title: |
| Click or tap here to enter text. |
| Phone No.: |
| Click or tap here to enter text. |
| Email: |
| Click or tap here to enter text. |
| Address: |
| Click or tap here to enter text. |
PAST PERFORMANCE QUESTIONNAIRE (CONTINUED)
4. PROJECT DESCRIPTION
Type of Work (check all that apply): ☐ VA ☐ Federal ☐ Medical ☐ Office ☐ Other:
Were any personnel from this referenced project also proposed as Key Personnel on the current solicitation? ☐ Yes ☐ No If yes, please provide the names and roles of that key personnel: Click or tap here to enter text.
DETAILED DESCRIPTION OF THE WORK PERFORMED
Click or tap here to enter text.
EXPLANATION OF RELEVANCY TO SOLICITATION REQUIREMENTS
Instructions for the Reference Completing This Questionnaire Please complete this questionnaire and return it directly to Josh Kovar (Joshua.Kovar@VA.gov) no later than 1:30 PM EST on November 23, 2026. The subject line of your email should read: "27Q0075 - PPQ, [Name of Offeror]". The Government reserves the right to verify all information provided on this form. To respond to a question, click the checkbox corresponding to your answer.
Rating Definitions Please use the following ratings and definitions when evaluating the Contractor's performance.
| RATING |
| DEFINITION |
| (E) Exceptional |
| Performance exceeded contractual requirements to the Government's benefit, with few or no problems encountered. No significant weaknesses were identified. |
| (VG) Very Good |
| Performance exceeded contractual requirements in at least one meaningful respect, with only minor problems that were effectively corrected. No significant weaknesses were identified. |
| (S) Satisfactory |
| Performance met contractual requirements. Any problems encountered were minor and were resolved satisfactorily. No significant weaknesses were identified. |
| (M) Marginal |
| Performance did not meet one or more contractual requirements. A significant problem occurred that the Contractor had difficulty resolving, or corrective action was not fully effective. |
| (U) Unsatisfactory |
| Performance did not meet most contractual requirements, and timely recovery is unlikely. Corrective actions taken were largely ineffective. |
| (N) Not Applicable |
| This item does not apply, or insufficient information is available to provide a rating. |
TO BE COMPLETED BY PPQ REFERENCE
PPQ REFERENCE
Name: Click or tap here to enter text.
Title: Click or tap here to enter text.
Agency/Company: Click or tap here to enter text.
Phone Number: Click or tap here to enter text.
Email Address: Click or tap here to enter text.
Contract No.: Click or tap here to enter text.
Contract Type: Click or tap here to enter text.
Contract Title: Click or tap here to enter text.
Contract Location: Click or tap here to enter text.
Describe your role in the project: Click or tap here to enter text.
Does the narrative in Section 4 accurately describe the scope, complexity, and relevance of the work? Please explain if not: Click or tap here to enter text.
Date Questionnaire Completed (mm/dd/yy): Click or tap here to enter text.
Signature: This form may be signed with a handwritten (physical) signature or a digital signature. Only one signature type is required.
| PHYSICAL SIGNATURE |
| DIGITAL SIGNATURE |
Sign by hand below (print this page if needed):
To apply a verified digital signature, use Insert > Text > Signature Line. Alternatively, insert an image of your signature below:Click or tap here to insert your digital signature.
Instructions: For each item below, please select the rating that best reflects your evaluation of the Contractor's performance. Rating definitions are provided on Page 3.
| 1. QUALITY |
| E |
| VG |
| S |
| M |
| U |
| N |
| (a) Quality of workmanship, quality of materials used, and overall appearance of work (if required). | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (b) Ability to meet quality standards specified for technical performance. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (c) Timeliness and effectiveness of contract problem resolution without extensive customer guidance. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (d) Adequacy and effectiveness of the Contractor's quality control program. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 2. SCHEDULE / TIMELINESS OF PERFORMANCE |
| E |
| VG |
| S |
| M |
| U |
| N |
| (a) Compliance with contract delivery/completion schedules, including significant intermediate milestones. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (b) Contractor's use of available resources to accomplish tasks identified in the contract. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (c) Timeliness of the Contractor's responses to questions and/or comments. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 3. CUSTOMER SATISFACTION |
| E |
| VG |
| S |
| M |
| U |
| N |
| (a) Extent to which end users were satisfied with the project. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (b) Contractor's reasonableness and cooperation in resolving disagreements or disputes. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (c) Extent to which the Contractor was cooperative, businesslike, and attentive to the customer's interests. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (d) Overall customer satisfaction. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
4. MANAGEMENT / PERSONNEL / LABOR
| E |
| VG |
| S |
| M |
| U |
| N |
| (a) Effectiveness of management, including management of subcontractors and/or labor force. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (b) Ability to hire and retain a qualified workforce. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (c) Government Information/Property Control. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (d) Knowledge and expertise demonstrated by Contractor key personnel. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (e) If a subcontracting plan was required, were small business goals met? | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (f) Ability to simultaneously manage multiple projects across multiple disciplines. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (g) Ability to assimilate and incorporate changes in requirements or priorities. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (h) Effectiveness of overall management, including the ability to lead and control the project. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 5. COST / FINANCIAL MANAGEMENT |
| E |
| VG |
| S |
| M |
| U |
| N |
| (a) Ability to meet the terms and conditions of the contractually agreed price(s). | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (b) Contractor proposed innovative methods or processes that reduced cost or improved outcomes. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 5. COST / FINANCIAL MANAGEMENT (CONTINUED) |
| Yes |
| No |
| (c) Is the Contractor's accounting system adequate for the management and tracking of costs? | |
| ☐ | ☐ |
| (d) Has this contract been partially or completely terminated for default or convenience, or is a termination pending? | |
| ☐ | ☐ |
| (e) Have there been any indications of financial problems on the part of the Contractor? | |
| ☐ | ☐ |
| 6. SAFETY / SECURITY |
| E |
| VG |
| S |
| M |
| U |
| N |
| (a) Ability to maintain a safe work environment and respond appropriately to safety issues. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (b) Compliance with general and IT security requirements, including personnel security requirements. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| 7. GENERAL |
| E |
| VG |
| S |
| M |
| U |
| N |
| (a) Ability to respond to emergency or surge situations, including timely notification of urgent issues. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (b) Compliance with contractual terms and provisions. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| (c) Overall rating of the work performed by this Contractor. | |||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
8. SUMMARY
Would you hire or work with this firm again? (If no, please explain in the comments section below.) ☐ Yes ☐ No
COMMENTS SECTION
Please provide any additional comments or narrative addressing specific strengths, weaknesses, deficiencies, or other information that may assist in evaluating performance risk. Specific examples are appreciated and help ensure an accurate evaluation.
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