Screening Information Request Attachment 4 - Past Performance Questionnaire

Attachment 4 (SIR # 697DCK-25-R-00368)

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

The Federal Aviation Administration (FAA) AIT (Office of Information Technology) is considering the Offeror listed below for a U.S. Government contract. Your comments would be appreciated regarding this firm’s past performance. After completing this PPQ, return it directly to this office via email to Ms. Kay F. Morello ([email protected] and [email protected]) no later than 5:00 PM ET on 9/21/2026. Your prompt response is greatly appreciated. If the referenced project is a government project, you may forward a copy of the official performance evaluation in lieu of completing this form. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM. Part I – Offeror’s Information (To be completed by Offeror) Offeror Information
Name of Offeror Being Evaluated:

Address of Offeror Being Evaluated:

CAGE Code of Offeror Being Evaluated:

UEI Number of Offeror Being Evaluated:

Part II- Contract Information (To be completed by Offeror’s Reference) Please provide the following information regarding the contractor identified in Part I above: Project Information
Contract Number:

Delivery/Task Order Number:

Contract/Project Title:

Location:

Award Date:

Completion Date:

Contract Value:

Offeror Performed As:
FORMCHECKBOX Prime Contractor
Describe how the work performed relates to the purchase of over 750+ printer consumables within the 48 United States, and the District of Columbia, to include non-foreign Outside Continuous United States locations.

Was the delivery timeline for four (4) -business days or less for CONUS/OCONUS orders?

FORMCHECKBOX Yes FORMCHECKBOX No

Did the contractor meet those delivery timelines more than 98% of the time? If not, what percentage?

FORMCHECKBOX Yes FORMCHECKBOX No

Part III – Ratings and Questions (To be completed by Offeror’s Reference) Evaluator Information
Name of Evaluator:
Government Agency/Commercial Company:

Address:

Phone Number:

Email Address:

Position Held in Relation to this Project:

Rating: Please evaluate the past performance using only the following ratings without variation. DO NOT RATE ON A “+” OR “-” SCALE. If a “+” or “-” is used, the rating without the “+” or “-” will be applied. If the rating is Marginal or Unacceptable, please provide additional information in the appropriate block or in the remarks section of this form. “E”
Exceptional
Performance greatly exceeded the contract requirements. “VG”
Very Good
Performance exceeded the contract requirements.