PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE QUESTIONNAIRE (Form PPQ)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information

Firm Name:CAGE Code:
Address:UEI Number:
Phone Number:
Email Address:
Point of Contact:Contact Phone Number:
189166512065003169920120650042799001206500527367512065002. Work Performed as: Prime ContractorSubcontractorJoint VentureOther (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):
109728011430002199640114300036048951143000Contract Type: Firm Fixed PriceCost ReimbursementOther (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): $0.00
Final Contract Price (to include all modifications, if applicable): $ Explain Differences:

4. Project Description:

119951512065001854835120650024237951206500Complexity of WorkHigh MedRoutine 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:

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATINGDEFINITIONNOTE

60198011049000

(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 been NO significant weaknesses identified.
(VG) Very Good
Performance meets contractual requirements and exceeds some to the Government’s/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.