RFP_W91242-17-R-0011_PPQ.pdf

PAST PERFORMANCE EVALUATION QUESTIONNAIRE FORM – W91242-17-R-0011

Contractor: Contract No.:

Subcontract No. (if applicable):

POC: Title:

(Name) (E.G. PCO/ACO/TM)

(Agency, Telephone No., E-mail Address & Fax Number)

The following questions pertain to the contractor’s record of past (within the past three years) and current performance.

The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that our information be as factual and accurate as possible. Please provide examples and/or explanations (use additional pages if necessary). The following adjectival ratings shall be used in your response.

Acceptable: Performance meets contractual requirements. Work was accomplished with some minor problems for which corrective actions taken by the contractor were satisfactory.

Unacceptable: Performance does not meet most contractual requirements. Serious problems with contractor performance were experienced for which the corrective actions were ineffective.

PART I. (To be completed by the Offeror)

Contractor/Company Name/Division:

Address:

Program Identification/Title:

Contract Number:

Contract Type:

Prime Contractor Name (if different from the contractor name cited above):

Contract Award Date:

Forecasted or Actual Contract Completion Date:

Nature of the Contractual Effort or Items purchased:

Name:

Title:

Date:

Telephone Number:

E-mail Address:

PART II. EVALUATION (To be completed by Point of Contact – Respondent)

Acceptable Unsatisfactory (Explanation must be provided in Comments field below)

Comments:

A. CONTRACT IDENTIFICATION

B. IDENTIFICATION OF OFFEROR’S REPRESENTATIVE

A. Compliance of Products, Services, Documents, and Related Deliverables to Specification Requirements and Standards of Good Workmanship

B. Effectiveness of Project Management (to include use and control of subcontractors).

C. Timeliness of Performance for Services and Product Deliverables.

Are you aware of other relevant past efforts by this company?

If yes, please provide the name and telephone number of a point of contact:

Organization:

Name:

Title:

Date:

Telephone Number

E-mail Address:

PART III. RETURN INFORMATION

Please return this completed Questionnaire via e-mail to Heather Bushouse at heather.m.bushouse.civ@mail.mil no later than Monday, 2 October 2017. Thank you for your assistance.

Signature Date

Typed or Printed Name

D. Effectiveness in Forecasting and Controlling Estimated Costs (Use this Question on Cost Reimbursement Type Contracts Only).

E. Commitment to Customer Satisfaction and Business-like Concern for its Customers’ Interest

F. General Comments. Provide any other relevant performance information.

G. Other Information Sources. Please provide the following information:

H. Respondent Identification. Please provide the following information:

mailto:heather.m.bushouse.civ@mail.mil