Past_Performance_Survey.doc
DOC document 35 KB Posted
- Attached to
- LA-SPEC AGNT-LACOMBE-JANITORIAL SERVICE
- Solicitation number
- 140FS325Q0027
About this file
This is a Past Performance Survey template form requesting details about a contractor's previous contract experience. The 5-page form requires companies to provide general business information including company leadership, UEI number, and organization type, followed by detailed information about three completed or in-progress contracts. For each contract, respondents must provide contracting agency, point of contact, contract number, dollar amount, project scope, role (prime/subcontractor/joint venture), subcontracting details, performance period, completion dates, quality control and safety plan usage, and any problems encountered and their resolutions.
The form is related to solicitation #140FS325Q0027 for janitorial services at LA-SPEC AGNT-LACOMBE, issued by the Department of the Interior Fish and Wildlife Service. The template itself does not contain any completed information - it is a blank form meant to be filled out by potential contractors to demonstrate their past performance capabilities.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS325Q0027_Amd_0002.pdf | ||
| Sol_140FS325Q0027_Amd_0001.pdf | ||
| B08_-_SOW.pdf | ||
| B03_-_Service_Contract_Act_WD___2015-5189.pdf | ||
| Sol_140FS325Q0027.pdf |
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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:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
c. Third Contract:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
4. Certification of Past Performance Information:
Type or Print Information
Name of Survey Preparer _______________________________Phone:_________________
E-Mail;___________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
File details come from the government source that posted it. Updated .