ATTACHMENT A- PAST PERFORMANCE QUESTIONNAIRE. Solicitation Attachment PDF Version

ATTACHMENT A, PAST PERFORMANCE QUESTIONNAIRE

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

1. CONTRACTOR/OFFEROR INFORMATION

Firm Name:
Address:
Phone Number:
DUNs Number:
SAM Unique Entity Identifier (UEI) Number:
Contact Name
Email Address: :
Contact Phone Number:

2. GENERAL WORK INFORMATION

Work was performed as: ☐ Prime Contractor ☐ Sub Contractor ☐ Joint Venture ☐ Other (Please explain):
Percent (%) of project work performed:
If a subcontractor, who was the prime (Name/Phone #):

3. CONTRACT INFORMATION

Contract Number:
Delivery/Task Order Number (if applicable):
Contract Type:
explain)

☐ Firm Fixed Price ☐ Cost Reimbursement ☐ Other (Please

Contract Title:
Contract Location:
Client Contact Information:
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
What is the degree of relevancy of this project? (Please provide details)

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 Point of Contact

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, there should have