Attach_04_PPQ.pdf
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- Attached to
- HURON NWR-LIGHTHOUSE ISLAND LEAD PAINT ABATEMENT
- Solicitation number
- 140F0222R0004
About this file
This solicitation is for lead paint abatement services at the Huron National Wildlife Refuge Lighthouse Island in Marquette County, Michigan. The contractor shall remove and properly dispose of exterior lead-based paint, repair and replace damaged boards, and paint buildings and structures on Lighthouse Island in accordance with historic preservation standards. Add alternates include interior lead paint removal and repainting of additional buildings. The work shall be performed on a firm fixed price lump sum basis between $100,000 and $250,000. Contractors must register in SAM and accept electronic payments. A virtual site visit will be held on January 25, 2022, and requests for information are due by February 11th. Proposals are due February 25th, with anticipated award by March 11th. The soliciting agency is the Department of the Interior Fish and Wildlife Service Region 2.
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Text version
ATTACHMENT 4 140F0222R0004 page 1 of 4
PAST AND 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:
Dun & Bradstreet Number: __
Is company a ; Partnership [ ] Separate entity [ ] Division [ ] N/A [ ]
2. CONTRACT BONDING INFORMATION
Name of your bonding company intended to use:
Mailing Address:
City, State (including ZIP Code):
Point of Contact: Telephone No.: ( )
3. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS
Complete and submit the information requested on page 2-3 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.
ATTACHMENT 4 140F0222R0004 page 2 of 4
a. First Contract:
Contracting Agency or Company:
Point of Contact: Telephone Number:
Contract Number: Contract/Subcontract Amount: $
Project Title and Location:
General Scope of Construction 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?
Were You Assessed Liquidated Damages?
(If the answer to either Question is “Yes”, Explain:
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 4 140F0222R0004 page 3 of 4
b. Second Contract:
Contracting Agency or Company:
Point of Contact: Telephone Number:
Contract Number: Contract/Subcontract Amount: $
Project Title and Location:
General Scope of Construction 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?
Were You Assessed Liquidated Damages?
(If the answer to either Question is “Yes”, Explain:
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 4 140F0222R0004 page 4 of 4
4. Certification of Past and Present Performance Information:
Type or Print Information
Name of Survey Preparer_______________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
| PAST AND PRESENT PERFORMANCE SURVEY |
| 1. GENERAL BUSINESS INFORMATION |
| 2. CONTRACT BONDING INFORMATION |
| 3. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS |
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