W912DW20R0017 Fuel Hydrant System Attachment 4 THE PAST PERFORMANCE QUESTIONNAIRE.DOCX
DOCX document 16 KB Posted
- Attached to
- FY20 Repair of Fuel Hydrant System, Spots 25-28 at Fairchild Air Force Base, Spokane, WA.
- Solicitation number
- W912DW-20-R-0017
About this file
This document contains a past performance questionnaire template to be completed for a federal contract opportunity to repair a fuel hydrant system at Fairchild Air Force Base in Washington. The opportunity is solicited by the U.S. Army Corps of Engineers and involves repairing the fuel hydrant system at spots 25 through 28 of the base. Offerors are required to provide references that will complete the past performance questionnaire, which collects information about prior contracts such as award amounts, completion dates, and a client review of performance. The template includes blocks for offerors and their references to provide details including contract numbers, descriptions of work performed, and a section for clients to rate performance and sign off on the questionnaire.
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Text version
SECTION 00 22 16 – ATTACHMENT 4
THE PAST PERFORMANCE QUESTIONNAIRE
NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (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, or other)
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:
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: CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO USACE. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.
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