Attach_3_Past_Performance_Survey.docx
DOCX document 25 KB Posted
- Attached to
- NJ-CAPE MAY NWR-HOMELESS ENCAMP CLEAN UP
- Solicitation number
- 140FS326Q0163
About this file
This is a Past Performance Survey template used to collect historical contract information from prospective contractors bidding on federal opportunities. The form requests general company information including firm establishment date, company leadership, UEI number, and small business status. Contractors must complete detailed information on up to three past or present contracts or subcontracts, whether government or commercial, including the contracting agency or company name, contract number, contract value, project title and location, scope of work, the contractor's role (prime, joint venture, or subcontractor), and subcontract details.
For each contract listed, the survey requires documentation of performance metrics including period of performance, scheduled and actual completion dates, percentage of work completed, termination history, quality control and safety plan implementation, and any quality control or safety problems encountered with corresponding resolutions. The form must be completed and signed by an authorized company representative with their name, title, phone number, email address, and date. This template is part of the solicitation 140FS326Q0163 for Cape May National Wildlife Refuge homeless encampment cleanup services managed by the Department of Interior Fish and Wildlife Service, with a project end date of March 31, 2027.
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Other files
| File | Type | Posted |
|---|---|---|
| Attach_2_SCA_Wage_Determination_Cape_May_NJ.pdf | ||
| Sol_140FS326Q0163.pdf | ||
| Attach_1_Statement_of_Work_Campsite_Clean-up_2026.pdf |
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Text version
ATTACHMENT 3 page 4 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.
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
P hone:_________________ E-Mail;___________________________ Title Signature Date )4. Certification of Past Performance Information:
File details come from the government source that posted it. Updated .