Solicitation Exhibit 5 - Past Performance Questionnaire

PBS PAST PERFORMANCE QUESTIONNAIRE

CONTRACT INFORMATION (Contractor/Offeror to complete Blocks 1-4)

1. CONTRACTOR/OFFEROR INFORMATION

Firm Name:
Address:
Phone Number:
Contact Name
Email Address: :

2. GENERAL WORK INFORMATION

Work performed as:
Prime Contractor
explain):

DUNs Number:
Contact Phone Number:

Sub Contractor

Joint Venture

Other (Please

Percent (%) of project work performed:
If a subcontractor, who was the prime (Name/Phone #):

3. CONTRACT INFORMATION

Contract Number:
Delivery/Task Order Number (if applicable):
Contract Type:
Contract Title:
Contract Location:

Firm Fixed Price

Cost Reimbursement

Other (Please explain)

Award Date (mm/dd/yy):
Contract Completion Date (mm/dd/yy):
Actual Completion Date (mm/dd/yy):
Explain Differences:
Original Contract Price (Award Amount):
Final Contract Price (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.)
INSTRUCTIONS FOR CLIENTS COMPLETING THIS QUESTIONNAIRE: PBS requests that the client completes this questionnaire and submits it directly back to the offeror. The offeror will submit the completed questionnaire to PBS with their proposal, and may duplicate this questionnaire for future submission on PBS solicitations. Clients are highly encouraged to submit questionnaires directly to the offeror. However, questionnaires may be submitted directly to PBS. Please contact the offeror for PBS POC information. The government reserves the right to verify any and all information on this form.

PBS Past Performance Questionnaire
July 2014

Use the following adjective ratings and definitions in your evaluation of the Contractor’s performance.

RATING

DEFINITION

NOTE

(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