Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- AR-CACHE RIV NWR-PLANTATION THINNING SERVICES
- Solicitation number
- 140FF027Q0065
- Issued by
- Not on record
About this file
This document is a Past or Present Performance Survey form designed to collect information about a contractor's relevant experience with completed or in-progress contracts or subcontracts.
The form requests general business information including company name, address, date established, UEI number from SAM.GOV, company leadership names, and small business status designation. Section 2 requires detailed documentation of up to three contracts or subcontracts, whether government or commercial. For each contract entry, the form collects the contracting agency or company name, point of contact information, contract number, dollar amount, project title and location, general scope of work, the company's role (prime, joint venture, or subcontractor), description of work performed, any subcontracted work and its value, performance period duration, scheduled and actual completion dates, percentage of work completed, termination status, and quality control and safety plan usage. Respondents must also document any quality control or safety problems encountered and describe their resolution. Section 4 requires certification by the survey preparer, including typed name, phone number, email address, title, signature, and date. Government contracts are preferred but not required; contractors without government experience may submit commercial contract data. This is a template form used during the federal solicitation process to evaluate contractor past performance capabilities.
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Text version
ATTACHMENT 3 page 1 of 5
PAST OR PRESENT PERFORMANCE SURVEY
Your Company Name:
Street Address:
City, State/Territory and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
Company President: Vice President:
WWW.SAM.GOV UEI Number:_______________ __
Is company a small business? YES [ ] NO [ ] 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.
http://www.sam.gov/
ATTACHMENT 3 page 2 of 5
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?
ATTACHMENT 3 page 3 of 5
b. Second Contract:
Point of Contact: Telephone Number:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: %
ATTACHMENT 3 page 4 of 5
c. Third Contract:
Point of Contact: Telephone Number:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: %
ATTACHMENT 3 page 5 of 5
4. Certification of Past Performance Information:
Type or Print Information
Name of Survey Preparer _______________________________
Phone:__________________________ E-Mail;___________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
| PAST OR PRESENT PERFORMANCE SURVEY |
| 1. GENERAL BUSINESS INFORMATION |
| 2. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS |
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