Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- GA-OKEFENOKEE NWR-00000-NEW VC ELECTRICA
- Solicitation number
- 140FF027Q0028
- Issued by
- Not on record
About this file
This is a Past Performance Survey form used to evaluate contractor experience and qualifications for federal contracting opportunities. The document serves as a template for companies to document their contracting history, including general business information, past or present contract performance, and quality and safety management practices. Companies must provide detailed information on up to three completed or in-progress contracts or subcontracts, including the contracting agency or company name, contract number, project title and location, contract amount, period of performance, scheduled and actual completion dates, and percentage of work completed. For each contract listed, respondents must identify their role as prime contractor, joint venture partner, or subcontractor and describe the scope of work performed, any subcontracted work and associated costs, termination status, and whether quality control and safety plans were implemented. The form also requires disclosure of any quality control or safety problems encountered and how they were resolved.
The survey concludes with certification and signature requirements from the survey preparer, including their name, title, phone number, email address, and date of submission. This form is designed to support past performance evaluation for the solicitation GA-OKEFENOKEE NWR-00000-NEW VC ELECTRICA (Solicitation Number 140FF027Q0028), which involves electrical work at the Okefenokee National Wildlife Refuge in Georgia. The template does not specify response deadlines, pricing terms, set-asides, or other procurement-specific details beyond the evaluation of contractor historical performance.
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Text version
PAST OR PRESENT PERFORMANCE SURVEY
Your Company Name:
Street Address:
City, State and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
| Company President: | Vice President: | |
| SAM.gov Unique Entity Identifier (UEI): | __ |
Is company a ; Partnership [ ] Separate entity [ ] Division [ ] N/A [ ]
2. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS
Complete and submit the information requested on page 2-4 below on prime contracts or subcontracts completed or in progress. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress.
a. First Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | ||
| Contract Number: | Contract/Subcontract Amount: $ | _____ |
Project Title and Location:
General Scope of Project: ____________
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
b. Second Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | ||
| Contract Number: | Contract/Subcontract Amount: $ | _____ |
Project Title and Location:
General Scope of Project: ____________
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
c. Third Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | ||
| Contract Number: | Contract/Subcontract Amount: $ | _____ |
Project Title and Location:
General Scope of Project: ____________
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
Type or Print Information Name of Survey Preparer
Phone:_________________ E-Mail;___________________________ Title Signature Date )4. Certification of Past Performance Information:
File details come from the government source that posted it. Updated .