Attachment 8: Past Performance Ques

ATTACHMENT

PAST PERFORMANCE QUESTIONNAIRE (Form PPQ)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information

Firm Name:
CAGE Code:
Address:
Entity Identifier Number:
Phone Number (include area code):
Email Address:
Point of Contact:
Contact Phone Number (include area code):

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/yyyy):
Contract Completion Date (mm/dd/yyyy):
Actual Completion Date (mm/dd/yyyy):
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/yyyy):

8. Client’s Signature:

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

DEFINITION

(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.

(VG) Very Good

Performance meets contractual requirements
and exceeds some to the
Government’s/Owner’s benefit. The