B08 - ATTACHMENT 0010 - Past Performance Questionnaire.pdf

PAST PERFORMANCE QUESTIONNAIRE

Past Performance Questionnaire (PPQ) Form

The Offeror must complete Sections IIA and IIB for each Past Performance reference and send copies to the PPQ respondent(s) identified in IIA in a timely manner. The Offeror shall include these documents with its proposal; however, the PPQ respondent will send the completed questionnaire directly to the POC identified in the PPQ Section IV below.

In order to assess potential contractors ACC-RI contracting office is obtaining past performance information with respect to each Offeror. The PPQ respondent will complete all sections of the Past Performance Evaluation Questionnaire except sections IIA and IIB. In addition to this questionnaire, you may receive a follow-up phone call or email to confirm or clarify information. This is a critical acquisition being conducted by ACC-RI and your support is sincerely appreciated.

Thank you for your time, effort, and cooperation in responding to this questionnaire.

The completed questionnaire shall be submitted directly via email to, Kelly Clifton, Contract Specialist, Kelly.k.clifton.civ@mail.mil.

The subject line in the submission email shall clearly indicate: ‘[Offeror Name] W52P1J- 18-R-0143 message shall originate from the PPQ respondent’s Government or corporate email address.

SECTION I. GENERAL GUIDANCE

Please use the following rating in scoring the performance elements below (assessments should reflect only contractor-liable performance):

RATING DESCRIPTION

Excellent The Offeror's past performance far exceeds the customer's expectations and provided significant, unusual worthwhile features or benefits.

Good The Offeror’s past performance exceeds the customer's expectations and provided significant, unusual worthwhile features or benefits.

Satisfactory The Offeror's past performance met the customer's expectations and contract requirements.

Marginal The Offeror's past performance could have been improved.

The Offeror required major agency resources to ensure achievement of contract requirements.

Unsatisfactory The Offeror's past performance did not meet customer expectations and/or contract requirements.

SECTION II. GENERAL INFORMATION

II-A RESPONDENT IDENTIFICATION / POC

1. Name & Title:

2. Organization:

3. Address:

4. Phone No:

5. E-mail:

6. Date:

II-B CONTRACT IDENTIFICATION

1. Offeror:

2.

DoD Entity (CAGE) Code of Evaluated Contractor:

3.

Type of Instrument - Contract/Order/Subcontract/Other:

4.

If Sub contract identify Prime Contractor:

5. Contract Identification Number:

6. Order Number (if applicable):

7.

Project Title and Demil Description (add rows if needed, up to 200 words):

8.

Pricing Type (e.g., Fixed Price, Time and Materials, Cost Reimbursable):

9. Date of Award:

10. Date work effort/contract will end:

11.

Initial Contract Dollar Value (w/Options):

12.

Current/Final Contract Dollar Value (w/Options):

Period of Performance (including all options)

14. Place(s) of Performance:

15. Contracting Officer Contract information

16. Technical COR Contact Information

II-C GENERAL INFORMATION

1.

Respondent’s Role (e.g., COR, Contracting Officer) for evaluated contract and length of time in role:

2.

Has this contract been partially or completely terminated? If yes, explain and identify type of termination (e.g., default, convenience).

3.

If this was an award or incentive fee contract, what percentage of the available fee did the Contractor receive (if applicable, breakout by performance period)?

4.

Were there any changes in contract dollar amounts throughout the life of the contract; and if so, please explain (e.g., Government or Contractor driven):

5.

Were there any PQDR’s issued on this contract; and if so please explain how resolved.

6. Compliance with FAT (if applicable)?

II-D CONTRACT PERFORMANCE

Please Rate This Contractor With Respect To:

A. Conforming to the contract requirements including specifications, standards of good workmanship, and technical direction:

Rating Excellent Good Satisfactory Marginal Unsatisfactory

Check

Comment:

B. Contractor’s ability to deliver according to the agreed-to schedule. What were the causes of any schedule variances?

C. Contractor’s ability to identify and correct problems and prevent or mitigate potential problems in a timely manner:

D. Satisfaction level of work effort performed:

E. Has the contractor demonstrated reasonable and cooperative behavior in dealing with your staff and other contractors (including responsiveness and the ability to successfully resolve disagreements/disputes):

F. Contractor’s compliance with security requirements OSHA and EPA:

G. Contractor’s ability to meet First Article Test (FAT) scheduling and did the product meet your required level of quality during production and the product delivery phases.

SECTION III. RETURN INFORMATION

When completed, please send electronically via email to: Kelly Clifton, Contract Specialist, Kelly.k.clifton.civ@mail.mil.