Attachment 4: Past Performance Questionnaire

Nutrition Care Food Service – Past Performance Questionnaire (PPQ) Attachment 4

Purpose: This PPQ is designed on behalf of the Nutrition Care Food Service Program for use by the Offeror to retrieve past performance data. The Defense Health Agency (DHA) will use the information provided for the Nutrition Care Food Service evaluation. Offeror Instructions:
1. The Offeror shall complete Part 1 and save.
2. The Offeror shall send the form to the point of contact (POC) for customers to complete Part 2: Performance Evaluation. The customer POC shall be someone with first-hand knowledge of the offeror’s performance or have access to first-hand records. 3. The customer shall complete Part 2, sign Part 2, and save “as a PDF document” with a signature. 4. The customer shall return to the completed, and signed, PPQ to the offeror. 5. The offeror shall include the completed PPQ in Volume IV of the proposal.

Part 1: (to be completed by the Offeror)

Offeror to complete responses below:

1. Offeror

Name:

2. Contractor performed as a

__ Prime
__ Subcontractor
3. Prime contractor name if different than above
Name:

4. Customer identified as

__ Commercial
__ Federal Government
__ State Government
__ Other:

5. Offeror Point of Contact (POC)

Name:
POC Phone Number:
POC Email:

6. Contract number

#:

7. Contract award date

Date:
8. Forecasted or actual contract completion date
Date:
9. Performance period being evaluated.
Performance Period:

10. The Offeror shall describe the scope of the contract. Provide a general description of services provided:

12. The offeror shall describe the magnitude of the contract. Total Contract Value: $

Obligated amount for this specific evaluation period (if different from total contract value): $

End of Part 1.

Part 2: (to be completed by the customer)
2.1. Administrative.

Customer to complete responses below:

1. Customer’s Company/Agency

Name:

2. Customer’s Company/Agency

Description:

3. Customer Point of Contact

Name:
Job Title:
Email:
Phone Number:
4. Please confirm that the contractor’s information provided in “Part 1” is accurate. __ Yes
__ No. If no, Please provide correction for here incorrect entry here:

2.2. Performance Level Descriptions. Please indicate the performance quality level achieved by the contractor in performance of the tasks listed below based on the performance level descriptions provided. Performance Level
Performance Level Description
Exceptional
The contractor’s performance meets contractual requirements and exceeds many requirements to the customer’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.