Attachment 7e.pdf

ATTACHMENT # Solicitation #

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PAST PERFORMANCE INFORMATION (PPI) COLLECTION DOCUMENT – PART 4C

WORK HISTORY/PAST PERFORMANCE INFORMATION QUESTIONNAIRE – KEY PERSONNEL

The offeror is solely responsible for ensuring all Past Performance Information (PPI) Collection documents are completed and received by the Government by the solicitation closing time and date.

Section 1

KEY PERSONNEL TO COMPLETE THIS SECTION:

For each current (within 3 years), relevant Key Personnel employment position you are submitting, utilize a separate PART 4C document)

Name of offeror firm:

Key Personnel Name:

Key Personnel Current Employer’s Name:

Key Personnel Email:

Key Personnel Phone:

Key Personnel FAX:

I am a proposed Key Personnel for an offer on DLA Disposition Service’s Solicitation No. __________________, closing time and date _____________________________, to provide ________________________________ services at __________________________________. As such, I have listed you as a reference for my work performed as an employee for your firm/agency. Your input on my performance is therefore requested as follows:

1) Please complete Sections 3a., 3b., and 3c. of this document (PART 4C) and submit the completed document (Sections 1, 2, 3a., 3b., and 3c.) as follows:

Either fax the completed document to: ATTENTION: _______________________________, Contracting ______________, at ____________________________ (fax number), OR provide a scanned copy of the completed document to: _______________________________, Contracting ______________, at __________________________________ (email). The Government must receive the completed document no later than the solicitation closing time and date.

Thank you.

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Section 2

KEY PERSONNEL TO COMPLETE THIS SECTION:

Provide the following for your PP Reference:

Firm’s/Agency’s name: _______________________________________________________________________________ Firm’s/Agency’s address: _____________________________________________________________________________ Point of Contact (POC): _______________________________________ Telephone Number: _____________________ Dates of employment: From: ___________________________To: _______________________________ Title: _____________________________________________________ Position held: _____________________________________________ How long in this position: __________________

In the space below, please provide a clear, concise description of:

1) The duties performed and training obtained for this position relevant to the solicitation requirements (e.g., level of experience in performing manifest tracking, billing, scheduling, other administrative responsibilities; site supervision, sample collection, forklift operation, other field work responsibilities, training certifications)

2) The industry-related contracts/projects you managed/worked on while in this position, to include the following information: (referenced DLA Disposition Services contracts require only provision of the contract # and title)

- Contract/project # and title

- Agency/firm that awarded the contract/project

- Total dollar value of the contract/project

- Total period of performance

- Location of performance

- Number of pickup locations

- Number of waste streams

- Types of waste streams

- Types of services provided

3) The approximate percentage of time spent performing each relevant duty per month

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Page 4 of 7 As of: 10.24.2011 Once this document has been completed, the information contained becomes Source Selection Sensitive in accordance with FAR 2.101 and 3.104.

Section 3a.

KEY PERSONNEL REFERENCE TO COMPLETE THIS SECTION:

Please acknowledge the completeness and accuracy of the employment history in Section 2 above:

____ YES Additional comments:

____ NO Please explain:

Section 3b.

Based on the following adjectival ratings scale, please evaluate the quality of the employee’s performance by selecting the appropriate ratings and applying to elements I through V on the following pages.

NOT

SCALE: APPLICABLE UNSATISFACTORY MARGINAL SATISFACTORY VERY GOOD EXCEPTIONAL

N/A 1 2 3 4 5

DEFINITIONS:

EXCEPTIONAL: Performance met and exceeded many required duties. The employee’s overall performance was considered highly successful.

VERY GOOD: Performance met and exceeded some required duties. The employee’s overall performance was considered very successful.

SATISFACTORY: Performance met required duties. The employee’s overall performance was considered successful.

MARGINAL: Performance did not meet some required duties. The employee’s overall performance was considered less than successful.

UNSATISFACTORY: Performance did not meet most required duties. The employee’s overall performance was considered unsuccessful.

NOT APPLICABLE: Self-explanatory.

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I. QUALITY OF PRODUCT/SERVICE

N/A 1 2 3 4 5

a. Knowledge of hazardous waste laws and regulations

b. Knowledge of transportation laws and regulations

c. Ability to manage contracts/projects

d. Ability to prepare manifests and land disposal notifications

e. Ability to prepare waste profiles

f. Ability to obtain and/or prepare other required reports and documentation

g. Ability to prepare hazardous waste for disposal, including packaging and labeling

h. Ability to conduct hazardous waste sampling

If assigning a rating of 2 or 1, please provide examples of how the employee did not meet contract requirements:

If assigning a rating of 4 or 5, please provide examples of how the employee exceeded contract requirements:

II. SCHEDULE

N/A 1 2 3 4 5

a. Adheres to scheduled performance timeframes

b. Coordinates and schedules required services to meet customer needs

c. Meets advance notice and scheduling requirements

d. Submits required documentation in a timely manner

(e.g., lab analysis reports, initial and return manifests, etc.)

e. Provides timely notification to appropriate personnel of problems that arise

If assigning a rating of 2 or 1, please provide examples of how the employee did not meet contract requirements:

If assigning a rating of 4 or 5, please provide examples of how the employee exceeded contract requirements:

III. BUSINESS RELATIONS

a. Demonstrates professionalism in performance of duties

b. Utilizes critical decision making skills

c. Displays adaptable and cooperative behavior in team environment

d. Develops and implements procedures to ensure successful completion of required services

e. Employs timely, effective resolution of problems

f. Exhibits proficient listening, writing and oral communications skills

If assigning a rating of 2 or 1, please provide examples of how the contractor did not meet contract requirements:

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If assigning a rating of 4 or 5, please provide examples of how the contractor exceeded contract requirements:

IV. MANAGEMENT OF KEY PERSONNEL

a. Displays flexible leadership skills to meet situational needs

b. Determines efficient allocation of qualified resources

c. Demonstrates effective management of employee performance

d. Exhibits responsive and effective problem resolution skills

If assigning a rating of 2 or 1, please provide examples of how the contractor did not meet contract requirements:

If assigning a rating of 4 or 5, please provide examples of how the contractor exceeded contract requirements:

V. UTILIZATION OF SMALL BUSINESS (as applicable)

a. Complies with all negotiated Subcontracting Plan goals

b. Complies with submission of timely, accurate, required Subcontracting

Plan reporting through eSRS

c. Complies with the requirements of FAR 52.219-8, Utilization of Small

Business Concerns

d. Complies with DLA Mentoring Business Agreement (MBA) goals

e. Complies with submission of timely, accurate, required DLA MBA periodic progress reports

If assigning a rating of 2 or 1, please provide examples of how the contractor did not meet contract requirements:

If assigning a rating of 4 or 5, please provide examples of how the contractor exceeded contract requirements:

Section 3c.

Other Comments (to include overall comments regarding highly rated or poorly rated performance):

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Would you recommend this employee for potential future employment? (Please check one of the following)

_____ DEFINITELY WOULD

_____ PROBABLY WOULD

_____ MIGHT OR MIGHT NOT

_____ PROBABLY WOULD NOT

_____ DEFINITELY WOULD NOT

If you have checked anything other than DEFINITELY WOULD recommend, please explain why:

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