Attachment 9-PPQ-ESS.pdf
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- Solicitation number
- W91QF4-26-R-A010
About this file
This is a Past Performance Questionnaire template used by the U.S. Army for evaluating contractor performance during the source selection process. The form is designed to collect objective feedback from clients or points of contact regarding a contractor's performance on specific projects completed within the last three years, with contractors permitted to submit a maximum of five projects for evaluation.
The questionnaire is divided into four main parts. Part I collects general information including contractor details (name, address, point of contact, phone, email) and evaluator information (name, title, agency/company, contact details). Part II requests project-specific information including contract number, project title and description of services, period of performance, contract type, initial and final contract values, and whether the contractor served as prime or subcontractor. Part III contains the performance evaluation using a six-point rating scale: Excellent (E), Good (G), Adequate (A), Marginal (M), Poor (P), and Neutral (N). Evaluation questions assess four primary categories—Quality of Work (four questions covering workmanship, quality control, documentation, and deficiency correction), Timely Performance (three questions on schedule adherence, delay resolution, and closeout activities), Management Effectiveness (five questions on supervision, working relationships, subcontractor management, regulatory compliance, and site safety), and Compliance & Safety (three questions on labor law compliance, safety plan implementation, and deficiency correction). Part IV requests overall assessment including ratings on contractor's overall performance, customer satisfaction, and likelihood of contract award, along with narrative comments section and evaluator certification. Completed questionnaires must be returned to Contracting Specialist Jazmin Burns at jazmin.burns.mil@army.mil by a deadline specified in the form.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 1 - Performance Requirements Summary (PRS) ESS.xlsx | XLSX spreadsheet | |
| Attachment 2 - Combined Deliverables and Project Schedule Requirements.xlsx | XLSX spreadsheet | |
| Attachment 5 - Service Order Form.xlsx | XLSX spreadsheet | |
| Attachment 7 - TRADOC_928-R_Submittal_Form.pdf | ||
| Attachment 3- Sterilized Combined Equipment List.xlsx | XLSX spreadsheet | |
| Attachment 4 - Service Log.xlsx | XLSX spreadsheet | |
| Attachment 8 Draft DD 254 ESS Maintenance.pdf | ||
| Solicitation - W91QF426RA010_Draft 20260226.pdf | ||
| Attachment 6 - UFGS 28 10 05 - IDS.pdf | ||
| Attachment 10- SCA Wage Determination_SAM.GOV.pdf | ||
| Pre-Solicitation Notice_ESS Fort Leavenworth.pdf |
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Text version
Past Performance Questionnaire
Instructions for the Offeror: Please complete Part I-A below. Forward this entire questionnaire to the client (point of contact) for each of the projects you wish to submit for evaluation (maximum of 5 projects within the last 3 years).
Instructions for the Respondent (Client/Evaluator): We kindly request your objective evaluation of the contractor's performance on the project referenced below. Your candid feedback is crucial for our source selection process. Please complete all sections and return this form to the Contracting Specialist (jazmin.burns.mil@army.mil) prior to the following date _____________.
Your responses will be kept confidential.
PART I: GENERAL INFORMATION
A. Contractor Information (To be completed by the contractor being evaluated)
| Contractor Name:
| Address:
| Point of Contact:
| Phone Number:
| Email:
B. Respondent/Evaluator Information (To be completed by the client)
| Evaluator Name:
| Title/Position:
| Agency/Company:
| Phone Number:
| Email:
PART II: PROJECT INFORMATION
(Please complete one questionnaire for each project) - PROJECT TITLE BELOW
Contract Number:
Project Title & Description of Services:
Period of Performance (Start/End Dates):
mailto:robert.m.parvin.civ@army.mil
Contract Type (e.g., FFP, T&M, etc.):
Initial Contract Value: $
Final Contract Value: $
Was the contractor the Prime or a Subcontractor? ☐ Prime ☐ Subcontractor
PART III: PERFORMANCE EVALUATION
A. RATING DEFINITIONS
Rating Description
Excellent (E) No doubt exists that the offeror successfully performed the required effort.
Good (G) Little doubt exists that the offeror successfully performed the required effort.
Adequate (A) Some doubt exists that the offeror successfully performed the required effort.
Marginal (M) Significant doubt exists that the offeror successfully performed the required effort.
Poor (P) It is extremely doubtful that the offeror successfully performed the required effort.
Neutral (N) No relevant past performance upon which to base a meaningful prediction.
B. EVALUATION QUESTIONS
For each question, please select the rating that best describes the contractor's performance.
1. Quality of Work | Question | Rating |
| Demonstrated quality workmanship and adherence to contract specifications. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Provided an adequate quality control plan and implemented it successfully. | ☐ E ☐ G ☐ A ☐
M ☐ P ☐ N | | Submitted required documentation correctly and in a timely manner. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Corrected any identified deficiencies in a timely manner. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N |
2. Timely Performance | Question | Rating | | Adhered to the approved project schedule. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Resolved any delays in a timely and effective manner. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Completed punch list items and project closeout activities promptly. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N |
3. Management Effectiveness
| Provided experienced and effective on-site supervision and management. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Maintained a professional and cooperative working relationship. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Effectively managed subcontractors and project resources. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Complied with all applicable laws and regulations. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Maintained adequate site clean-up and safety. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N |
4. Compliance & Safety
| Complied with all applicable labor laws and standards. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Implemented the safety plan satisfactorily. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Corrected any identified labor or safety deficiencies in a timely manner. | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N |
PART IV: OVERALL ASSESSMENT & COMMENTS
1. General Questions | Question | Response |
| How would you rate the contractor's overall performance on this project? | ☐ E ☐ G ☐ A ☐ M ☐ P ☐ N | | Was the customer satisfied with the final product/service? | ☐ Yes ☐ No | | Would you award another contract to this contractor? | ☐ Yes ☐ No |
If you answered "No" to any of the questions above, please explain in the comments section.
2. Narrative Comments (Please provide any additional comments that would be helpful in evaluating this contractor's past performance. Attach additional pages if necessary.)
3. Certification
I certify that the information provided is accurate and complete to the best of my knowledge.
Signature of Evaluator
Date
| for our source selection process Please complete all sections and return this form to the: |
| Please complete one questionnaire for each project: |
| Contract Number: |
| Project Title Description of Services: |
| Period of Performance StartEnd Dates: |
| Initial Contract Value: |
| fill_10: |
| Final Contract Value: |
| fill_11: |
| Was the contractor the Prime or a Subcontractor: |
| Subcontractor: |
| undefined: Off |
| Prime: Off |
| Demonstrated quality workmanship and adherence to contract specifications: Off |
| E: Off |
| G: Off |
| A: Off |
| Provided an adequate quality control plan and implemented it successfully: Off |
| E_2: Off |
| G_2: Off |
| A_2: Off |
| M: Off |
| P: Off |
| M_2: Off |
| P_2: Off |
| Submitted required documentation correctly and in a timely manner: Off |
| E_3: Off |
| G_3: Off |
| A_3: Off |
| M_3: Off |
| N: Off |
| Corrected any identified deficiencies in a timely manner: Off |
| E_4: Off |
| G_4: Off |
| A_4: Off |
| M_4: Off |
| P_3: Off |
| Adhered to the approved project schedule: Off |
| E_5: Off |
| G_5: Off |
| A_5: Off |
| M_5: Off |
| P_4: Off |
| Resolved any delays in a timely and effective manner: Off |
| E_6: Off |
| G_6: Off |
| A_6: Off |
| M_6: Off |
| P_5: Off |
| Completed punch list items and project closeout activities promptly: Off |
| E_7: Off |
| G_7: Off |
| A_7: Off |
| M_7: Off |
| P_6: Off |
| Provided experienced and effective onsite supervision and management: Off |
| E_8: Off |
| G_8: Off |
| A_8: Off |
| undefined_2: Off |
| P_7: Off |
| Maintained a professional and cooperative working relationship: Off |
| E_9: Off |
| G_9: Off |
| A_9: Off |
| M_8: Off |
| P_8: Off |
| Effectively managed subcontractors and project resources: Off |
| E_10: Off |
| G_10: Off |
| A_10: Off |
| M_9: Off |
| P_9: Off |
| Complied with all applicable laws and regulations: Off |
| E_11: Off |
| G_11: Off |
| A_11: Off |
| M_10: Off |
| P_10: Off |
| Maintained adequate site cleanup and safety: Off |
| E_12: Off |
| G_12: Off |
| A_12: Off |
| M_11: Off |
| P_11: Off |
| Complied with all applicable labor laws and standards: Off |
| E_13: Off |
| G_13: Off |
| A_13: Off |
| M_12: Off |
| P_12: Off |
| Implemented the safety plan satisfactorily: Off |
| E_14: Off |
| G_14: Off |
| A_14: Off |
| M_13: Off |
| P_13: Off |
| Corrected any identified labor or safety deficiencies in a timely manner: Off |
| E_15: Off |
| G_15: Off |
| A_15: Off |
| M_14: Off |
| P_14: Off |
| How would you rate the contractor: Off |
| P_15: Off |
| s overall performance on this project: Off |
| E_16: Off |
| G_16: Off |
| A_16: Off |
| Was the customer satisfied with the final productservice: Off |
| Yes: Off |
| Would you award another contract to this contractor: Off |
| Yes_2: Off |
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