Attachment_1_PPQ.doc

ATTACHMENT 1

PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information

Firm Name:

CAGE Code:

Address:

DUNs Number:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Other (Explain) Joint Venture Sub Contractor Prime Contractor Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Other (Please specify):

Cost Reimbursement Firm-Fixed-Price Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work Routine Med High How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information

Name:

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: USACE REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO USACE WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON USACE SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO USACE. PLEASE CONTACT THE OFFEROR FOR USACE POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

1. Quality of Work:

a) How was the contractor’s compliance with applicable safety standards to protect personnel and company/agency resources?

FORMCHECKBOX

Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

b) How was the contractor’s compliance with applicable labor standards?

FORMCHECKBOX

Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

c) Was the contractor’s effort in Quality Control successful in ensuring quality workmanship on your project?

FORMCHECKBOX

Unsatisfactory

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Marginal

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Satisfactory

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Very Good

FORMCHECKBOX

Excellent

d) Was the contractor committed to customer satisfaction?

FORMCHECKBOX

Unsatisfactory

FORMCHECKBOX

Marginal

FORMCHECKBOX

Satisfactory

FORMCHECKBOX

Very Good

FORMCHECKBOX

Excellent

e) Overall rating for Quality of Work

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Unsatisfactory

FORMCHECKBOX

Marginal

FORMCHECKBOX

Satisfactory

FORMCHECKBOX

Very Good

FORMCHECKBOX

Excellent

2. Cost Controls:

a) Did the Contractor perform the required services at the contract price without adverse effect on performance?

FORMCHECKBOX

Unsatisfactory

FORMCHECKBOX

Marginal

FORMCHECKBOX

Satisfactory

FORMCHECKBOX

Very Good

FORMCHECKBOX

Excellent

b) Did the contractor submit a fair and reasonable proposal when requested to perform additional work?

FORMCHECKBOX

Unsatisfactory

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Marginal

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Satisfactory

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Very Good

FORMCHECKBOX

Excellent

c) If this contract is an indefinite delivery type contract (e.g., Multiple Award Environmental Contract, Task Order Contract, etc.), has the Contractor submitted competitive quotes on the individual orders issued under this contract?

FORMCHECKBOX

Yes

FORMCHECKBOX

No

FORMCHECKBOX

N/A

d) Overall rating for Cost Controls

FORMCHECKBOX

Unsatisfactory

FORMCHECKBOX

Marginal

FORMCHECKBOX

Satisfactory

FORMCHECKBOX

Very Good

FORMCHECKBOX

Excellent

3. Timeliness of Performance:

a) Was the contractor timely in submitting schedules, reports, billings and other contract submittals?

FORMCHECKBOX

Always

FORMCHECKBOX

Usually

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Sometimes

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Never

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N/A

b) Was the contractor timely in responding to requests for proposals for additional work?

FORMCHECKBOX

Always

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Usually

FORMCHECKBOX

Sometimes

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Never

FORMCHECKBOX

N/A c) Did the contractor complete the contract on time taking into account all excusable delays?

FORMCHECKBOX

Yes

FORMCHECKBOX

No

FORMCHECKBOX

N/A

d) Was the contractor assessed any liquidated damages or deductions for late or nonperformance of required work? If yes, please explain.

FORMCHECKBOX

Yes

FORMCHECKBOX

No e) Did the contractor exceed contractual requirements in relation to Timeliness of Performance in a way that was deemed beneficial to your agency?

FORMCHECKBOX

Yes

FORMCHECKBOX

No

FORMCHECKBOX

N/A

If you answered No, indicate your reason by checking one of the following:

Contractor met the requirements, but did not exceed them

Did not meet some of the requirements

Did not meet requirements and recovery is not likely

f) Overall rating for Timeliness of Performance

FORMCHECKBOX

Unsatisfactory

FORMCHECKBOX

Marginal

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Satisfactory

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Very Good

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Excellent

4. Effectiveness of Management:

a) Did the contractor award subcontracts in a timely manner and properly manage them?

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Always

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Usually

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Sometimes

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Never

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N/A

b) If applicable, did the contractor meet its small, small disadvantaged and women-owned business participation goals?

FORMCHECKBOX

Yes

FORMCHECKBOX

No

FORMCHECKBOX

N/A

c) How would you rate the management of this firm as it relates to the completion of your contract and to the qualifications of its on-site personnel. Please explain.

FORMCHECKBOX

Unsatisfactory

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Marginal

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Satisfactory

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Very Good

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Excellent

d) Describe the performance of the following personnel (if applicable)

1. Program Manger

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U

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M

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S

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VG

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E

2. Project Manager

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U

FORMCHECKBOX

M

FORMCHECKBOX

S

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VG

FORMCHECKBOX

E

3. Engineering/Technical

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U

FORMCHECKBOX

M

FORMCHECKBOX

S

FORMCHECKBOX

VG

FORMCHECKBOX

E

4. Quality Control Manager

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U

FORMCHECKBOX

M

FORMCHECKBOX

S

FORMCHECKBOX

VG

FORMCHECKBOX

E

5. Safety Officer

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U

FORMCHECKBOX

M

FORMCHECKBOX

S

FORMCHECKBOX

VG

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E

6. Superintendent

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U

FORMCHECKBOX

M

FORMCHECKBOX

S

FORMCHECKBOX

VG

FORMCHECKBOX

E

5. Customer Satisfaction:

a) Did the Contractor show reasonable and cooperative behavior and attention to customer satisfaction?

FORMCHECKBOX

Yes

FORMCHECKBOX

No

N/A

If you answered NO, please explain why:

6. Overall Rating of Contractor:

In summary, which of the following would you choose to best describe the overall quality of this firm’s past performance?

Unsatisfactory

FORMCHECKBOX

Marginal

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Satisfactory

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Very Good

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Excellent

7. Contact Information:

Name of Person Completing Form

Position

Project Description

Role of Contractor

Phone No.

The information in this Questionnaire may be verified by Personnel from the U.S. Army Corps of Engineers, Sacramento District.