Attachment 21 - Past Performance Questionnaire.pdf

PAST PERFORMANCE RISK ASSESSMENT QUESTIONNAIRE (PPQ)

Solicitation Reference Number: W912DY25R0025

Contractor Name:

Cage Code:

DESCRIPTION: 88th RD North Plains Region (W912DY25R0025)

NOTE: Contractor should identify the project being evaluated in the Technical Approach and Experience.

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

PART I. (To be completed by the Contractor)

(1) Contractor Name:

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

(3) CAGE Code:

(4) 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):

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

(6) CAGE Code (if different from the contractor name cited above):

(7) Title of Project:

(8) Description of Work:

(9) Location of Work:

(10) Date of Award:

(11) Status: ☐ Active ☐ Complete, Completion Date:

(12) Name and telephone number of Technical Representative:

PART II. EVALUATION. (To be completed by the technical representative identified in line

12. 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: (Insert additional comments here)

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

Excellent ☐ Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐

Remarks: (Insert additional comments here)

(3) Please evaluate the contractor's compliance with administrative contractual requirements such reporting, deliverables, etc.

Excellent ☐ Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐

Remarks: (Insert additional comments here)

(4) If given the opportunity, would you work with this contractor again?

☐ Yes ☐ No ☐ Not Sure

OTHER REMARKS (Please use the space below to provide other pertinent information related to the Contractor's performance):

PART III. RETURN INSTRUCTIONS.

Please return this completed Questionnaire via e-mail to the following email addresses:

Mallory.E.Hayes@usace.army.mil; Brandon.Walsh@usace.army.mil

Thank you for your assistance.