Revised Attachment 03 - Past Performance PPQ.pdf

ATTACHMENT 03: PAST PERFORMANCE QUESTIONNAIRE

TO THE EVALUATOR:

The Contractor named below is submitting a proposal to the Mission and Installation

Contracting Command (MICC) - Dugway Proving Ground for a contract to provide

Environmental Support Services, including Hazardous Waste Management, Groundwater

Monitoring, and RCRA/CAA compliance.

To assist us in evaluating their past performance, please complete this questionnaire and email it directly to the Contract Specialist, Amy Eilerts, at amy.m.eilerts.civ@army.mil no later than 26 May 2026. Your responses will be treated as Source Selection Sensitive. Do not return this form to the Contractor.

SECTION 1: CONTRACTOR IDENTIFICATION (TO BE COMPLETED BY OFFEROR)

Company Name: ______________________________________________________

Contract Number: ____________________________________________________

Contract Value: $_____________________________________________________

Period of Performance: ________________________________________________

SECTION 2: EVALUATOR IDENTIFICATION (TO BE COMPLETED BY

EVALUATOR)

Evaluator Name: ______________________________________________________

Title / Role (e.g., COR, KO, PM): ________________________________________

Agency / Organization: ________________________________________________

Phone Number: ______________________________________________________

Email Address: _______________________________________________________

SECTION 3: PERFORMANCE EVALUATION

Please rate the Contractor's performance in each area using the following scale. (If you rate any area as Marginal or Unacceptable, please provide an explanation in Section 4).

[A] ACCEPTABLE: Performance met or exceeded contract requirements. Any minor problems were resolved effectively.

[M] MARGINAL: Performance did not meet some contractual requirements. The contractor's corrective actions were only marginally effective or not fully implemented.

[U] UNACCEPTABLE: Performance failed to meet most contract requirements. Corrective actions were ineffective, or the contractor exhibited a pattern of non-compliance.

[N/A] NOT APPLICABLE: The contractor did not perform this type of work under the referenced contract.

Performance Area A M U N/A

1. Environmental & Waste Management: Ability to safely manage, classify, sample, and transport hazardous/non-regulated waste in compliance with state and federal regulations.

2. Regulatory Compliance: Adherence to complex state-issued permits (e.g., RCRA Part B, Title V Air Permits) without receiving Notices of Violation (NOVs) or major discrepancies.

3. Complex Sampling & Monitoring: Effectiveness in executing large-scale environmental sampling programs (e.g., Groundwater, UST, Asbestos/Lead-Based Paint).

4. Deliverables & Reporting: Timeliness, accuracy, and data validation quality of regulatory reports, manifests, and field activity logs.

Performance Area A M U N/A

5. Key Personnel & Management: Effectiveness of the site manager and technical specialists in proactively identifying issues, managing subcontractors, and communicating with the Government.

6. Safety & Security: Compliance with installation safety protocols, PPE requirements, and secure information handling.

SECTION 4: NARRATIVE / REMARKS

Please describe any significant accomplishments or severe performance problems.

(Mandatory if any "Marginal" or "Unacceptable" ratings were given above):

Did the Government issue any Cure Notices, Show Cause Letters, or Contract Discrepancy

Reports (CDRs) to this contractor? If yes, please explain:

☐ Yes ☐ No

OVERALL RATING: Based on your experience, would you award another contract to this company for similar environmental services?

☐ YES (Acceptable)

☐ NO (Unacceptable)

Evaluator Signature: _____________________________________ Date: ___________________

Did the Government issue any Cure Notices, Show Cause Letters, or Contract Discrepancy Reports (CDRs) to this contractor? If yes, please explain::