Attachment_2_Past_Performance_Survey.doc
DOC document 56 KB Posted
- Attached to
- TRAIL GRAVEL AT ASSABET NWR MA
- Solicitation number
- 140FS325Q0087
About this file
The document is a Past Performance Survey form for collecting detailed contractor information, specifically related to the Trail Gravel at Assabet National Wildlife Refuge (NWR) solicitation (140FS325Q0087) issued by the Department of the Interior Fish and Wildlife Service. The comprehensive five-page survey requires potential contractors to provide extensive details about their business and up to three prior contracts, including contract amounts, performance periods, roles, subcontractor information, quality control plans, safety plans, and potential performance issues.
The survey captures critical contractor qualifications such as business establishment date, company leadership, SAM.gov UEI number, and small business status. For each contract, respondents must document detailed performance metrics including contract value, project scope, role (prime/subcontractor), percentage of work completed, termination status, and resolution of any quality or safety problems. The form concludes with a certification section where the survey preparer must provide contact information and sign, validating the accuracy of the submitted past performance information.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_1_Assabet_Trail_Gravel_SOW.pdf | ||
| Sol_140FS325Q0087.pdf |
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Text version
ATTACHMENT 2 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.
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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