Attachment_03_20160923_N6_BLANK_PPQ_Fillable.pdf

PAST PERFORMANCE RISK ASSESSMENT QUESTIONNAIRE (PPQ)

W912DY-17-R-0003 RFP – Navy Phase 6 RM&MR

RFP NO: W912DY-17-R-0003

DESCRIPTION: DLA-Energy Petroleum Facilities Recurring Maintenance and Minor/Emergency Repairs for Navy Phase 6

NOTE: Offeror shall incorporate into the past performance section of the proposal, page one (1) of each PPQ sent to evaluators. In the event that an evaluator does not return a completed PPQ, the Government will call to verify information provided on page one. The government does not anticipate calling evaluators that have returned a completed PPQ.

Evaluator, Please provide your candid responses. The information that you provide will be used in the awarding of a federal contract. Therefore, it is important that your information be as factual, accurate and complete as possible to preclude the need for follow-up by the evaluators.

PART I. (To be completed by the Offeror)

(1) Contractor Name:

(2) Contractor Address (Street, City and State):

(3) Contract Number:

Type of Contract: “C” Contract, ID/IQ task order, GSA order, Other (Specify):

Type of Pricing Arrangement: Fixed Price Cost Reimbursement Other (Specify):

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

(5) Title of Project:

(6) Description of Work:

(8) Location of Work:

(9) Date of Award: (mm/dd/yyyy)

(10) Status: Active Complete, Completion Date:

(11) Name, telephone number, and email address of Technical Representative:

PART II. EVALUATION (To be completed by the technical representative identified on line 11 – If unavailable, to be completed by a technical representative knowledgeable of the contractor’s responsibilities and performance.

(1) Please evaluate the contractor's performance regarding compliance with the statement of work:

Excellent

Good

Satisfactory

Marginal

Unsatisfactory

Remarks:

(2) Please evaluate the contractor's performance regarding overall technical expertise demonstrated.

Excellent

Good

Satisfactory

Marginal

Unsatisfactory

Remarks:

(3) COMPLIANCE WITH ADMINISTRATIVE CONTRACTUAL REQUIREMENTS

Please evaluate the contractor's performance regarding items such reporting, deliverables, etc.

Excellent

Good

Satisfactory

Marginal

Unsatisfactory

Remarks:

If given the opportunity, would you work with this contractor again? Yes No Not Sure

OTHER REMARKS:

(1) Please use the space below to provide other information related to the contractor's performance.

PART III. RETURN INSTRUCTIONS

Please return this completed Questionnaire via e-mail to the following email addresses: Karen.Spanier@usace.army.mil and Tisha.M.Fitch@usace.army.mil

Thank you for your assistance.

mailto:Karen.Spanier@usace.army.mil mailto:Tisha.M.Fitch@usace.army.mil