Past Performance Questionnaire Past Performance Questionnaire Franklin County OH

PART I. PAST PERFORMANCE QUESTIONAIRE (PPQ) COVER PAGE

RLP No.: 36C10F25R0057

Offeror Entity Name:

1. CONTRATOR INFORMATION

Project Reference No.:
Contact Name:
Contact Phone/Email:

Entity Name:
Entity Address:

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:
Contract No.:
Contract Award Date:
Contract Completion Date:

If Other, Explain:
Place of Performance:
Price at Award:
Price at Completion:

4. REFERENCES

Contracting Officer/Signature Authority
Name:
Title:
Phone:
Email:

Resident Engineer/Technical Representative
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

VA Form – Past Performance Questionnaire (REV. Feb. 2026)

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
Name:
Title:
Phone:
Email:

Resident Engineer/Technical Representative
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
Use the following adjective ratings and definitions in your evaluation of the Contractor’s performance.

RATING

(E) Exceptional

(VG) Very Good

(S) Satisfactory

(M) Marginal

(U) Unsatisfactory

(N/A) Not Applicable

DEFINITION

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.
Performance meets contractual requirements and
exceeds some to the Government’s benefit. The
contractual performance of the element or sub-element