B08_24Q0037_Amend0001_Final.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

Solicitation W9126G24Q0037-Medical Surveillance Services, Amendment 0001 - Government response to questions and remove the Site Visit Requirement.

See SF 30 Block 14 Continuation Page and Summary of Changes.

POC: Kimberly Logan, Contract Specialist, kimberly.a.logan@usace.army.mil

1. CONTRACT ID CODE PAGE OF PAGES

J 1 12

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 16-Apr-2024

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street , County, State and Zip Code) X W9126G24Q0037

X 9B. DATED (SEE ITEM 11)

05-Apr-2024

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer is extended, X is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN

REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

16-Apr-2024

CODE

US ARMY CORPS OF ENGINEERS FORT WORTH

819 TAYLOR ST, CT OFC RM 2A17

FORT WORTH TX 76102-0300

W9126G 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W9126G24Q0037

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by full text:

AMENDMENT 0001

Amendment 0001

This amendment is for the following:

a. Provide Government response to questions received at of April 16, 2024. The cut off date and time for questions remains April 18, 2024 at 1:00 PM CDT.

b. Update the Quote Content and permit offerors to submit an alternative quote in addition to a quote meeting the terms and conditions of this solicitation.

c. The Site Visit is cancelled.

d. The date and time for quote submission remains unchanged.

Government Response to Vendor Questions

Question Government Response Contract Section / Document (PWS, Bid Schedule, Staff Matrix, Wage Determinations)

ADMINISTRATIVE QUESTIONS

Is this a brand new contract or is /was there an incumbent?

This is not a new requirement.

Previous contract was awarded under contract W9126G20P0120 on 10 Aug 2020 to IH2S, LLC for a base year plus two options periods with a period of performance of 10 Aug 2020 to 09 Aug 2023.

N/A

Is the Government amendable to receive an RFQ utilizing an alternative option to the requirement for a mobile unit?

Vendors shall submit one quote IAW the terms and conditions of the RFQ as it is written. However, the Government will consider an alternative quote that offers a costs savings or innovative business solution to meet the requirements of the PWS. The vendor shall identify the "Alternative" quote by labeling the submittal IAW the submittal procedures identified in paragraph 7(j) of the Instructions to Offerors.

Quote Content, Page 4 of 43

TECHNICAL QUESTIONS

1.7.1 YEARLY SERVICE: This is

a one-time per year contract to be performed as near as possible to one year after the prior testing from the date of contract award. Once a year on site at Sam Rayburn project office, once a year at Lake O’ the Pines project office and provide a

Yes, this is a one time per year contract per location, (Sam Rayburn – Lake O’ the Pines).

There will need to be a facility provided so that that we can send employees for testing outside of those times for example, new employees.

PWS

location within a fifty-mile radius of Sam Rayburn and Lake O’ the Pines for individuals that require testing outside of the annual sequence.

These two test locations are 140 miles apart, then we need to supply year round access to both locations?

Please clarify the difference between the audio booth

vs. audio room mentioned in the solicitation.

We are simply requesting an audiometry test. If the testing facility (area) meets the standards of the industry, it will suffice.

PWS

SECTION SF 1449 - CONTINUATION SHEET

The following have been modified:

INSTRUCTIONS TO OFFERORS

Combined Synopsis / Request for Quotes (RFQ)

Solicitation Number: W9126G24Q0037

Solicitation is issued by:

US ARMY CORPS OF ENGINEERS FORT WORTH

819 TAYLOR ST, CT OFC RM 2A17

FORT WORTH TX 76102-0300

PROJECT NAME: Piney Woods Region (PW) Medical Surveillance Services

1. This is a combined synopsis/solicitation for commercial services prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; quotes are being requested and a written solicitation will not be issued.

The U.S. Army Corp of Engineers (USACE), Fort Worth District intends to establish a Single Award, Purchase Order (P) Contract for non-personal serves to perform the services listed below in the description.

1.1 Description of Services: The Contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, supervision, and any other items necessary to effectively perform medical testing services as defined in the Performance Work Statement (PWS) with the exception of those items specified as government furnished property and services. The Contractor shall perform to the current existing medical standards in this contract.

1.2. Scope: The Contractor shall perform medical testing for employees at Piney Woods Projects. Contractor will provide an on-site mobile unit that can meet the requirements listed in the PWS and provide the medical surveillance with minimal disruption of the workers day.

Work shall be performed in support of the USACE Piney Woods (PW) Region - Designated areas at Sam Rayburn/Town Bluff Projects, Jasper/Woodville, Lake O’ the Pines, Jefferson, Lake Wright Patman, Texarkana, and Jim Chapman Lake, Sulphur Springs, Texas.

Periods of Performance will be one (1) twelve (12) month base period, and two (2) twelve (12) month option periods.

The government reserves the right to limit and/or not respond to any further questions pertaining to this project received after April 18, 2024 at 1:00 PM CDT. Offerors should base their quotes on the information provided in the solicitations and all issued amendments thereto.

All answers to technical inquiries and questions are reviewed by the Contracting Officer prior to the response date.

Answers to technical inquiries may result in amendment(s) to the solicitation. If an amendment is issued, it will be posted on the Government Point of Entry website www.sam.gov.

2. This is a Request for Quote (RFQ) and incorporates FAR provisions and clauses in effect through the Federal Acquisition Circular (FAC) 2024-03 (23 Feb 2024). Solicitation document and incorporated provisions and clauses are those in effect through the Federal Acquisition Regulation (FAR) and Department of Defense FAR Supplement

(DFARS).

a. The provision at 52.212-1, Instructions to Offerors -- Commercial, applies to this acquisition and a statement regarding any addenda to the provision. Offerors are also required to submit a completed copy of the Request for Quotation and a completed copy of the pricing schedule.

b. Offerors include a completed copy of the provision at 52.212-3, Offeror Representations and Certifications- Commercial Items, with its offer.

c. Clause at 52.212-4, Contract Terms and Conditions-Commercial Items, applies to this acquisition and a statement regarding any addenda to the clause.

d. Clause at 52.212-5, Contract Terms and Conditions Required To Implement Statutes or Executive Orders- Commercial Items, applies to this acquisition and a statement regarding which, if any, of the additional FAR clauses cited in the clause are applicable to the acquisition

3. This acquisition is SET ASIDE 100% for Small Business.

4. PSC: Q403 Medical-Evaluation/screening

NAICS CODE: 621111 – Offices of Physicians (except Mental Health Specialists)

SIZE STANDARD: $16M

5. System for Awards Management (SAM): In accordance with FAR 52.204-7(b)(1) An Offeror is required to be registered in SAM when submitting an offer or quotation and shall continue to be registered until time of award, during performance, and through final payment of any contract, basic agreement, basic ordering agreement, or blanket purchasing agreement resulting from this solicitation.

6. Evaluation Information: The Government intends to award a firm fixed price (FFP) Single Award P Contract resulting from this RFQ to the responsible offeror whose offer represents the best value in terms of price, past performance and technical approach and Understanding of the Work IAW 13.106-2(b)&(3).

Quote Content – All quotation documents when printed shall fit on 8 x 11inch paper to include spreadsheets (with the appropriate page breaks). Ensure the quote is submitted in PDF format. In-order to be considered responsive to the RFQ, the prospective offeror’s quote shall consist of the four electronic volumes identified below and include the required information specified below.

The Quote shall consist of the following electronic Volumes:

1) Technical Volume

2) Past Performance Volume

3) Price Volume

4) Submittals Volume

Quotes shall be responsive to and comply with the terms of the combined synopsis solicitation, in order to be eligible to receive an award. All combined synopsis/solicitation requirements shall be addressed in sufficient written detail for the Government to determine if the offeror understands each aspect of the Government’s requirement. The offeror/quoter shall address each task separately and shall sufficient narrative and supporting data for each task.

Lack of sufficient detail shall be considered sufficient cause for the quote to be determined unacceptable. Statements that the quoter understands, can or will comply with all specifications and statements paraphrasing the specifications or parts thereof, or phrases such as “standard procedures will be used” or “well-known techniques will be used” will be considered unacceptable. The Government will reject the proposal if determined to be materially non-responsive or that does not conform to the terms of the combined synopsis/solicitation.

Quoters that fail to adhere to the submittal requirements will be determined non-responsive and will be considered ineligible for award. To be eligible to receive an award, the quote submitted in response to the combined synopsis/solicitation shall consist of the contents required in the sub-paragraphs described below:

a. Technical Volume (1 PDF document): Specifications have been defined in the Performance Work Statement (PWS). The vendor shall submit a technical quote that meets or exceeds all specifications identified in the PWS.

The Technical Volume shall not contain any pricing information and shall address the vendor’s understanding of the work. (See FAR Clause 52.212-2 Evaluation – Commercial Items). Vendors shall submit one quote IAW the terms and conditions of the RFQ as it is written. However, the Government will consider an alternative quote that offers a costs savings or innovative business solution to meet the requirements of the PWS. The vendor shall identify the "Alternative" quote by labeling the submittal IAW the submittal procedures identified in paragraph 7(j) of the Instructions to Offerors.

Table 1. Technical Acceptable/Unacceptable Ratings

Rating Description Acceptable Proposal meets the requirements of the solicitation.

Unacceptable Proposal does not meet the minimum requirements of the solicitation.

b. Past Performance Volume (1 PDF document): The past performance evaluation results in an assessment of the offeror’s probability of meeting the solicitation requirement. The past performance evaluation considers each offeror’s demonstrated recent and relevant record of performance of supplying the products and services that meet the contract’s requirements. In accordance with FAR 15.305(a)(2), the recency and relevance of the information, source of the information, context of the data, and general trends in contractor’s performance shall be considered.

These shall be combined to establish a performance confidence assessment rating for each offeror, as described in the following paragraphs.

Recency is defined work completed within the past four (4) years.

Relevance is defined as similar work in size and scope.

NAVFAC/USACE Past Performance Questionnaire (PPQ): The quoter is required to submit one (1) PPQ with an overall rating of satisfactory or higher to be considered eligible for award. Additional PPQs submitted for assessment will be discarded and not considered for evaluation. The Contracting Officer may use additional data obtained from any available sources such as the Past Performance Information Retrieval System (PPIRS) and personal knowledge to assess the contractor’s likelihood of success in performing the solicitation’s requirements as indicated by those offerors’ record of past performance.

If for any reason, the contractor does NOT have recent or relevant past performance, the quoter is still required to submit a PPQ with a brief narrative explaining “No Recent or Relevant Past Performance”. In the case of a quoter without a record of recent or relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past performance. Therefore, the quoter shall be determined to have unknown or (“neutral”) past performance. In the context of eligibility, a “Neutral” adjectival rating shall be considered eligible for award. Contractor’s that have proven past performance ratings with an adjectival rating below “Satisfactory” shall not be ineligible to receive consideration for award.

A contractor’s past performance rating may be used at the Contracting Officer’s discretion to make an overall determination of the level of confidence the government has in the contractor’s capability to perform the service.

The Contracting Officer may determine that a “Substantial Confidence” or “Satisfactory Confidence” past performance rating is worth more than a “Neutral Confidence” past performance rating as stated in the evaluation.

While the Government may elect to consider data from other sources, the burden of providing detailed, current, accurate and complete past performance information rests with the Quoter.

Table 2. Past Performance Relevancy Adjectival Rating Rating Description

(E) Exceptional Performance meets contractual requirements and exceeds many to the

Government/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

(VG) Very Good

Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

(S) Satisfactory Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

(M) Marginal Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

(U) Unsatisfactory

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

(N) Neutral In the case of a quoter without a record of recent or relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably

Table 3. Past Performance Confidence Adjectival Rating

Adjectival Rating Description Substantial Confidence Based on the offeror's recent/relevant performance record, the Government has a high expectation that the offeror will successfully perform the required effort.

Satisfactory Confidence Based on the offeror's recent/relevant performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort

Neutral Confidence No recent/relevant performance record is available or the offeror' s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned. The offeror may not be evaluated favorably or unfavorably on the factor of past performance.

Limited Confidence Based on the offeror' s recent/relevant performance record, the Government has a low expectation that the offeror will successfully perform the required effort.

No Confidence Based on. the offeror's recent/relevant performance record, the Government has no expectation that the offeror will be able to successfully perform the required effort.

In performing the past performance factor evaluation, evaluators will apply the following relevance levels to assess the relevance of the prior contract effort(s) of offerors.

Table 4. Past Performance Relevancy Ratings

Rating Definition

Very Relevant Present/past performance effort involved essentially the same scope and magnitude of effort and complexities this solicitation requires.

Relevant Present/past performance effort involved similar scope and magnitude of effort and complexities this solicitation requires.

Somewhat Relevant Present/past performance effort involved some of the scope and magnitude of effort and complexities this solicitation requires.

Not Relevant Present/past performance effort involved little or none of the scope and magnitude of effort and complexities this solicitation requires.

c. Price Volume (1 PDF document): A Firm Fixed Price (FFP) shall be submitted for this effort. The vendor will provide pricing for each line item listed in the attached Price Exhibit. Vendor total price quote include Labor Categories, Labor and Labor Rates (See Attached Staff Matrix). The Government will evaluate all aspects of the price proposal for reasonableness. Proposals found to be unreasonable may be rejected on that basis. The Government will only award the required Purchase Order Contract if a pre-priced list for services that fair and reasonable price can be obtained.

In accordance with FAR Part 29.3 – State and Local Taxes, and per Title 4 of US Code 104-07, the Government is exempt from paying state and local taxes.

d. Submittals Volume (1 PDF document): The Submittals volume shall consist of the Vendor Information

Sheet, provisions at 52.204-24, and 52.204-26, 52.212-3 Dev, 52.219-1, and 52.219-28, NIST information and Representation and Certifications in accordance with the provisions at FAR 52.212-3.

The offeror agrees to hold the prices in its offer firm for 60 calendar days from the date specified for receipt of offers.

Quotes for this solicitation are due no later than (NLT) April 29, 2024, by 1:00 PM CDT.

Electronic copies of each volume shall be submitted directly to the Contract Specialist, Kimberly Logan, kimberly.a.logan@usace.army.mil. It is the Offeror’s responsibility to obtain written confirmation of receipt of all electronic files of the full proposal by the Fort Worth District Contracting office. The Offeror must obtain prior approval from the Contracting Officer (Jamauh D. Winston), jamauh.d.winston@usace.army.mil or the Contract Specialist (Ms. Kimberly Logan) kimberly.a.logan@usace.army.mil to use an alternate submission method.

Offerors are responsible for ensuring electronic copies are virus-free and shall run an anti-virus scan before submission.

Electronic copies of each volume shall be compatible with the following software products: Adobe Acrobat Reader and Microsoft Office 365. Narrative portions of the proposal shall be in Adobe Acrobat portable document file (pdf) searchable text format. The Offeror shall not embed sound or video (e.g., MPEG) files into the proposal files.

Electronic files shall be clearly identified for each volume, section, and item. Electronic files shall be not be larger than 5MB.

7. Submittals:

a. Technical Submittal (Approach and Understanding of Work) (See Clause 52.212-2 Evaluation – Commercial Items), Shall not exceed five (5) pages. Compile the technical submittal and submit as one conformed document.

Label Submittal: Company Name, Technical Quote, Example: ABC, LLC Technical Quote 24Q0037

b. Past Performance NAVFAC/USACE Past Performance Questionnaire (See Clause 52.212-2 Evaluation – Commercial Items). Recent or relevant work is defined as similar work in size and scope within the past four (4) years. If for any reason the contractor does NOT have recent or relevant past performance, the offeror is still required to submit a PPQ with a brief narrative explaining, "No Recent or Relevant Past Performance in block 6 of the PPQ Contractor Information Sheet. The Contracting Officer shall deem an offeror non-responsive if the offeror fails to submit a PPQ. An Offeror that submits a PPQ that is deemed neither recent nor relevant will be treated as “NEUTRAL”. PPQ Submittals shall consist of the Contractor Information Sheet and the Completed Adjectival Rating Sheets. Compile the two (2) PPQs and submit them as one conformed document (2) Label Submittal:

Company Name, PPQ, Example: ABC, LLC PPQ 24Q0037

c. Price / Pre-Priced Bid Schedule. Incomplete bid schedules will be rejected and the quoter will be deemed non- responsive. Vendor may submit the completed Bid Schedule and Staff Matrix as separate Excel files. Label Submittal: Company Name, Price Quote, Example: ABC, LLC PPQ 24Q0037

d. Complete and return the provisions at 52.204-24, and 52.204-26, 52.212-3 Dev, 52.219-1, and 52.219-28.

Compile the Provisions and submit as one conformed document. Label Submittal: Company Name, Submittal Quote, Example ABC, LLC Provisions 24Q0037

e. If applicable, acknowledge and return any amendments with your submittals. Compile the amendments and submit as one conformed document. Label Submittal: Company Name, Submittal Quote, Example ABC, LLC

AMD 0001 – 0004 24Q0037

f. Offerors must submit representation and certifications in accordance with the provisions at FAR 52.212-3 Offeror Representation and Certifications – Commercial Item (Accessible at https://www.acquisition.gov ) or the vendor may verify their Online Representation and Certification Application (ORCA) is updated in SAM by checking “Yes” on the Vendor information sheet. The contract specialist will verify the quoters FAR & DFAR Reports are updated in SAM.GOV prior to determining the quoter responsive. Label Submittal: Company Name, Submittal Quote, Example ABC, LLC Submittals Quote 24Q0037

g. Please NOTE this solicitation requires offerors to enter a National Institute of Standards and Technology (NIST) score in the Supplier Performance Risk System (SPRS) prior to responding to this solicitation. The NIST score is a responsiveness item. Bids/offers from contractors with a NIST score in SPRS will be considered responsive and evaluated/considered. Those without a NIST score in SPRS will be deemed NON-RESPONSIVE and thus not evaluated/considered for award. * If the apparent awardee does not correct the omission by refusing to enter its NIST score within 14 days after the allotted time then it can be safely deemed “not responsive”. Screen Shot of the Offerors NIST/SPRS Assessment. Compile the assessments and submit as one conformed document. Label Submittal: Company Name, Submittal Quote, Example ABC, LLC NIST/SPRS 24Q0037

Reference: 252.204-7019 - Notice of NIST SP 800-171 DoD Assessment Requirements Reference: 252.204-7020 - NIST SP 800-171 DoD Assessment Requirements See the Attached Quick Entry Guide to assists with entering NIST Assessment.

Contact Help Desk at (866)618-5988 for additional assistance

h. Contractors that failure to adhere to the submittal requirements will be determined non-responsive and will be considered ineligible for award.

9. 52.237-1 SITE VIST – CANCELLED.

Offerors or quoters are urged and expected to inspect the site where services are to be performed and to satisfy themselves regarding all general and local conditions that may affect the cost of contract performance, to the extent that the information is reasonably obtainable. In no event shall failure to inspect the site constitute grounds for a claim after contract award.

Prospective offerors/quoters are required to contact the Contract Specialist via email to express their interests by 3:00 PM (CST) two business days prior to attending the site visit. Site visit attendees must provide the following information the Solicitation Number, Project Title, Name(s) of Individual(s) who will attend the site visit, Name of Company Represented, Phone Number of Company being represented. All attendees required sign attendance sheet.

Date: CANCELLED

VENDOR INFORMATION SHEET

Sam Rayburn Medical Surveillance Services

COMPANY NAME

POC

(Last, First Middle)

ADDRESS

(Number & Street) (City, State and Zip)

PHONE NUMBER MOBILE

(Area code and number) (Area code and number)

EMAIL ADDRESS___________________________________________

Unique Identity NUMBER CAGE CODE NUMBER_______________

Vendor’s Online Representation and Certification Application (ORCA) are updated in SAM Yes No

Signature Date

ATTACHMENT 1

NAVFAC/USACE PAST PERFORMANCE QUESTIONAIRE (Form PPQ-0)

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: Prime Contractor Sub Contractor Joint Venture Other (Explain) 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: Firm Fixed Price Cost Reimbursement Other (please specify):

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 High Med Routine 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: NAVFAC/USACE REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNARIE AND

SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED

QUESTIONNARIE TO USACE WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS

QUESTIONNAIRE FOR FUTURE SUBMISSION ON USACE SOLICITATION. 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.

(End of Summary of Changes)