PAST PERFORMANCE QUESTIONNAIRE Form.pdf

ATTACHMENT J-4

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

Submission Instructions: The company who has provided you with this questionnaire is responding to a Department of the Treasury, Request For Proposals TOFS-10-S-0003 to obtain contract support for Financial Services. All information must be typed.

Questionnaire About (Completed by requesting company/contractor)

Company/Contractor Providing Services

Company/Contractor Address

Description of Services Provided

Company/Contractor’s role, to include whether work was performed as a prime or subcontractor

Contract Number/Identifier

Original Contract Estimated Value Estimated Value at Completion

Percentage of Work Complete Contract Performance Period

Contract Type (Fixed Price, T&M, Cost, etc.)

Questionnaire Completed By (Completed by reviewing company/agency)

Thank you, in advance, for providing us with valuable information needed to conduct a past performance evaluation.

Upon completion of this questionnaire, please send a signed, scanned version as an email attachment directly to FSACQ@do.treas.gov no later than 4:00 PM EST on May 30, 2010. In the email subject line, please state “PPQ Submission.” If you have any questions related to completing and/or submitting this questionnaire, please contact the following Contract Specialist at the Department of the Treasury: 1) Peggy Wright at 202-435-5791, or 2) Eric Islinger at 202-435-5780.

Name

Title

Company/Agency

Address

Telephone Email Address

Signature Date

Question Instructions: Please answer questions 1 through 8 by providing a brief statement of your observations during the time you received support/services from the requesting company. If applicable, please include any problem(s) or performance failure(s) that prompted your comment. Additional pages may be attached if necessary.

Contractor is defined as the requesting company which provides services to the reviewing company/agency.

Questions (Completed by reviewing company/agency)

1.

Describe the contractor’s technical expertise.

Comments:

2.

Describe the quality of service you received from the contractor, including their ability to deliver competent personnel.

3.

Describe the contractor’s commitment to small business participation.

4.

Describe whether the contractor performed within budget and their efforts to control costs.

5.

Describe the contractor’s responsiveness to adjust to contract, program and/or schedule changes, and to meet established deadlines.

6.

Describe the contractor’s identification and mitigation of project related risks.

7.

Describe the contractor’s willingness to work as a team with your personnel and with contractor staff from other companies.

8.

Please provide any additional information to assist us in conducting our evaluation.