Attachment 2: PBS Past Performance Questionnaire

ATTACHMENT 2, PBS PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor/Offeror to complete Blocks 1-4)

1. CONTRACTOR/OFFEROR INFORMATION

Firm Name
Address
Phone Number
UEI Number
Contact Name
Contact Email Address
Contact Phone Number

2. GENERAL WORK INFORMATION

Work performed as:

Percent (%) of project work performed:
If a subcontractor, who was the prime?
(Name/Phone #)

​ Prime Contractor
​ Subcontractor
​ Joint Venture
​ Other (Please explain):

ATTACHMENT 2, PBS PAST PERFORMANCE QUESTIONNAIRE

3. CONTRACT INFORMATION

Contract Number
Delivery/Task Order Number
Contract Type

​ Firm Fixed Price
​ Cost Reimbursement
​ Other (Please explain):

Contract Title
Contract Location

Award Date (mm/dd/yyyy)
Contract Completion Date
(mm/dd/yyyy)
Actual Completion Date
(mm/dd/yyyy)
Explain differences, if any

Original Contract Price
(Award Amount)
Final Contract Price (to
include all modifications, if
applicable)
Explain Differences, if any

Complexity of Work

How is this project relevant to
the project of submission?
(Please provide details such as
similar equipment,
requirements, conditions, etc.)

​ High
​ Medium
​ Routine

INSTRUCTIONS FOR CLIENTS COMPLETING THIS QUESTIONNAIRE: PBS requests that the client completes this questionnaire and submits it directly back to the offeror. The offeror will submit the completed questionnaire to PBS with their proposal, and may duplicate this questionnaire for future submission on PBS solicitations. Clients are highly encouraged to submit questionnaires directly to the offeror. However, questionnaires may be submitted directly to PBS. Please contact the offeror for PBS POC information. The government reserves the right to verify any and all information on this form.

Use the following adjective ratings and definitions in your evaluation of the Contractor’s performance.

RATING

DEFINITION

NOTE

(E)
Exceptional

Performance meets contractual requirements
and exceeds many to the
Government/Owner’s benefit. The contractual
performance of the element or sub-element
being assessed was accomplished with few
minor problems for which corrective actions
taken by the contractor was highly effective.

An Exceptional rating is appropriate when the
Contractor successfully performed multiple
significant events that were of benefit to the
Government/Owner. A singular benefit,
however, could be of such magnitude that it
alone constitutes an Exceptional rating. Also,