Attachment 4: to Instructions - Past Performance Questionnaire Form

[FORM IS ONLY REQUIRED WHEN SUBMITTING A PAST PROJECT THAT

DOES NOT HAVE A CPARS EVALUATION (SEE RFP PARAGRAPH 3.1.10).]

ATTACHMENT 4 TO PHASE 1 RFP

PAST PERFORMANCE QUESTIONNAIRE

NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (Form PPQ‐0)

CONTRACT INFORMATION (Contractor to complete Blocks 1‐4)

1. Contractor Information

Firm Name:
CAGE Code:
Address:
DUNs Number:
Phone Number:
Email Address:
Point of Contact:
Contact Phone Number:
2. Work Performed as: ☐Prime Contractor ☐Sub Contractor ☐Joint Venture ☐Other (Explain) Percent of project work performed:
If subcontractor, who was the prime (Name/Phone #):

3. Contract Information

Contract Number:
Delivery/Task Order Number (if applicable):
Contract Type: ☐Firm Fixed Price ☐Cost Reimbursement ☐Other (Please specify): Contract Title:
Contract Location:
Award Date (mm/dd/yy):
Contract Completion Date (mm/dd/yy):
Actual Completion Date (mm/dd/yy):
Explain Differences:
Original Contract Price (Award Amount):
Final Contract Price (to include all modifications, if applicable): Explain Differences:

4. Project Description:

Complexity of Work: ☐High
☐Med ☐Routine
How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)
CLIENT INFORMATION (Client to complete Blocks 5‐8)

5. Client Information

Name:
Title:
Phone Number:
Email Address:
6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: USACE REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO USACE WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON USACE SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER,

*** DO NOT INCLUDE ANY LINKS OR REFERENCES TO OTHER SUBMISSIONS ***

QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO USACE. PLEASE CONTACT THE OFFEROR FOR USACE POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING

(E) Exceptional

(VG) Very Good

(S) Satisfactory

(M) Marginal

(U) Unsatisfactory

(N) Not Applicable

DEFINITION

NOTE

Performance meets contractual requirements and
exceeds many to the Government/ Owner’s benefit.
The contractual performance of the element or sub‐