55107 Past Performance Questionnaire

RFP: 70Z04026QSBPL0015

Past Performance Questionnaire

U.S. COAST GUARD

C4IT Service Center-CPD-C3CEN
4000 Coast Guard Blvd., Annex 4
Portsmouth, VA 23703-2199

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

I.

INSTRUCTIONS

The company (i.e., contractor) that sent you this questionnaire intends to submit an offer in response to a U.S. Coast Guard solicitation and has identified you as a reference to validate their performance. This PPQ must be completed by the person most familiar with the contractors’ performance on a present or previous contract and then submitted directly to the U.S. Coast Guard by the person completing the PPQ. Please DO NOT send the completed PPQ to the contractor being evaluated. In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information. We are thanking you in advance for your time, effort, and cooperation in responding to this questionnaire.
Please submit the completed
[email protected].

form

to

the

Contract

Specialist

via

e-mail

to

Please contact the Contract Specialist, Regina Elliott-Dougherty, at (571) 610-1960 if you have any questions. The completed PPQ is due on or before 05 NOVEMBER 2026 2:00 PM Eastern, unless the due date is extended via a Solicitation Amendment.
II.

GENERAL INFORMATION

A.

PAST PERFORMANCE EVALUATOR & ORGANIZATION/COMPANY INFORMATION

Your Name:

Your Title:
Your Organization/
Company Name:
Address:

Your Phone Number:

Your Fax Number:

Your E-mail Address:

Date:

Your Signature:

“Source Selection Information—See FAR 2.101 and 3.104.”

RFP: 70Z04026QSBPL0015

B.

Past Performance Questionnaire

CONTRACTOR NAME & CONTRACT IDENTIFICATION

Name of Contractor being evaluated:
Type of Instrument (e.g., Contract,
Purchase Order, Task Order, Other):
Pricing Type (e.g., Fixed Price, Time &
Material, Cost Reimbursement, Other):

Contract or Reference Number:

Subcontract Number (if applicable):

Order Number (if applicable):

Role of Contractor listed in #1 above
(if sub, also provide name of prime)

Description of Service/Supply:

Competitive (Y/N):

Prime Contractor
Subcontractor

10 Follow-On (Y/N):

11 Date of Award:

Initial Contract Dollar Value
(w/Options):

13 Final Contract Dollar Value (w/Options):

14 Period of Performance:

15 Place(s) of Performance:

Complexity of Work
(e.g., difficult, routine):

17 If applicable , type and extent of subcontracting:

“Source Selection Information—See FAR 2.101 and 3.104.”

RFP: 70Z04026QSBPL0015

III.

Past Performance Questionnaire

GENERAL GUIDANCE