Attachment B - Past Performance Questionnaire

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION

APPENDIX D: NAVFAC I USACE Past Performance Questionnaire (PPQ) Form PPQ -0 (9/30/11)

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:

2. Work Performed as:

Prime Contractor
Sub Contractor
Percent of project work performed:
If subcontractor, who was the prime (Name/Phone #):

Joint Venture

Other (Explain):

3. Contract Information

Contract Number:
Delivery/Task Order Number (if applicable):
Contract Type:
Firm Fixed Cost
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 Cost (Award Amount):
Final Contract Cost (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: NAVFAC/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. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

FOR OFFICIAL USE ONLY

SOURCE SELECTION INFORMATION

NAVFAC I USACE Past Performance Questionnaire (PPQ) Form PPQ -0 (9/30/11)

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.
Performance meets contractual requirements
and exceeds some to the