Past Performance Questionnaire - Past Performance Questionnaire

PART I. PAST PERFORMANCE QUESTIONAIRE (PPQ) COVER PAGE

RLP No.:

Offeror Entity Name:

1. CONTRATOR INFORMATION

Project Reference No.:

Entity Name:
Contact Name:
Entity Address:
Contact Phone/Email:

UEI No.:

2. GENERAL WORK INFORMATION

Work Performed For:
Customer Name (if Non-VA):

Work Performed As:
Percentage (%) of Work Performed:

3. CONTRACT DETAILS

Type of Contract:

If Other, Explain:
Contract No.:
Place of Performance:
Contract Award Date:
Price at Award:
Contract Completion Date:
Price at Completion:

4. REFERENCES

Contracting Officer/Signature Authority

Resident Engineer/Technical Representative
Name:
Title:
Phone:
Email:
Name:
Title:
Phone:
Email:

5. PROJECT DESCRIPTION

(Attach additional pages if needed)

Project Size:

Type of Facility/Work:

If Other, Explain:

Detailed Description of the Work Performed/Explanation of Relevancy to RLP Requirements:

Key Personnel Names/Roles (Indicate if Assigned to Current Solicitation):

Major Subcontractor(s) Names/Roles:

6. OFFEROR CERTIFICATION OF PART I

I certify that the information provided in this PPQ is accurate and complete.

Signature

Date

PART II (A). PAST PERFORMANCE QUESTIONAIRE INFORMATION

Requested by:

Completed by:
Date Completed:

1. CONTRACT DETAILS

Contract No.:

All contract details and description of work performed outlined in Part I of this PPQ is accurate: If not, please explain:
(additional space for comments is provided on page 4)

2. REFERENCES

Contracting Officer/Signature Authority

Resident Engineer/Technical Representative
Name:
Title:
Phone:
Email:
Name:
Title:
Phone:
Email:

Describe Your Role in the Project:

3. REFERENCE CERTIFICATION OF PART II

I certify that the information provided in this PPQ is accurate and complete.

Signature

Date

RATING

DEFINITION

NOTE

(E) Exceptional
Performance meets contractual requirements and exceeds many to the Government 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. 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 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.