Attachment_2_Past_Performance_Survey.doc
DOC document 36 KB Posted
- Attached to
- Amphibious ATV for Cache River Arkansas
- Solicitation number
- 140FS324Q0211
About this file
This document is a Past Performance Survey that is required to be submitted as part of a federal contract opportunity. The key details are:
The contract opportunity is for an Amphibious ATV vehicle to be delivered to the Cache River National Wildlife Refuge in Arkansas. The government agency issuing the solicitation is the Department of the Interior Fish and Wildlife Service. The solicitation number is 140FS324Q0211. Contractors should review the attached specifications for details on the required equipment. Contractors must complete and submit the provided Past Performance Survey with their quote. The survey requests information on up to three past or current contracts, including the contracting agency, contract value, period of performance, quality control and safety plans used, and any problems encountered. This information is used to evaluate the contractor's relevant past performance.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_1_ATV_Specifications.pdf | ||
| Sol_140FS324Q0211.pdf | ||
| Attachment_2_Past_Performance_Survey.pdf |
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Text version
ATTACHMENT 2 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:
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__________________________________________
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