Solicitation- PPQ.pdf

PAST PERFORMANCE QUESTIONNAIRE

This survey will be used to evaluate past performance for the contractor and contracting actions for the requirements of Solicitation W91248‐21‐Q‐0001.

Candid feedback is important to the evaluation effort and may affect award outcome. Please indicate "NA" in any area which is not applicable to work performed by your organization. The past performance information must have occurred within the last 3 years to be deemed recent; and be relevant to the tasks identified in the PWS of this solicitation.

PAST PERFORMANCE

1. Contractor information:

Contractor _________________________________________________________________

Address ___________________________________________________________________

Telephone Number __________________________________________________________

Point of Contact ____________________________________________________________

2. Contract Number _________________________________________________________

a. Type of Contract: (Circle one) Local State Federal

Contract Number: __________________________________________________________ (Check type of contract below)

Fixed Price: Price for Contract negotiated and fixed prior to delivery of service.

Time & Material: Price for Contract determined by number of hours or quantities of materials used in the delivery of service based, upon previously fixed price rates for time and material.

Cost Reimbursement: Provides for payment of allowable incurred costs to the extent prescribed in the contract.

b. Acquisition Method: Competitive ( ) yes ( ) no Sole Source ( ) yes ( ) no

c. Award Amount $________________ Final Cost $ _____________________

d. Performance Period _________________________ Is this an ongoing contract: _________

e. Briefly describe the deliverables or type of service(s) performed

3. Contract Number _________________________________________________________

a. Type of Contract: (Circle one) Local State Federal

Contract Number: __________________________________________________________ (Check type of contract below) Fixed Price: Price for Contract negotiated and fixed prior to delivery of service.

Time & Material: Price for Contract determined by number of hours or quantities of materials used in the delivery of service based, upon previously fixed price rates for time and material.

Cost Reimbursement: Provides for payment of allowable incurred costs to the extent prescribed in the contract.

b. Acquisition Method: Competitive ( ) yes ( ) no Sole Source ( ) yes ( ) no

c. Award Amount $________________ Final Cost $ _____________________

d. Performance Period _________________________ Is this an ongoing contract: _________

e. Briefly describe the deliverables or type of service(s) performed

4. Contract Number _________________________________________________________

a. Type of Contract: (Circle one) Local State Federal

Contract Number: __________________________________________________________ (Check type of contract below) Fixed Price: Price for Contract negotiated and fixed prior to delivery of service.

Time & Material: Price for Contract determined by number of hours or quantities of materials used in the delivery of service based, upon previously fixed price rates for time and material.

Cost Reimbursement: Provides for payment of allowable incurred costs to the extent prescribed in the contract.

b. Acquisition Method: Competitive ( ) yes ( ) no Sole Source ( ) yes ( ) no

c. Award Amount $________________ Final Cost $ _____________________

d. Performance Period _________________________ Is this an ongoing contract: _________

e. Briefly describe the deliverables or type of service(s) performed