Attachment_2_Past_Performance_Survey.doc
DOC document 35 KB Posted
- Solicitation number
- 140FS325Q0114
About this file
This document is a Past Performance Survey form designed to capture detailed information about a company's previous contract work. The form requires companies to provide comprehensive details about up to three contracts, including agency/company name, contract number, contract amount, project title and location, role (prime, joint venture, or subcontractor), scope of work, subcontractor details, performance period, completion status, and quality control/safety plan information.
The survey is associated with a specific federal contract opportunity for gravel delivery at Mattamuskeet National Wildlife Refuge in North Carolina, issued by the Department of the Interior Fish and Wildlife Service (Solicitation Number: 140FS325Q0114). The form allows potential contractors to demonstrate their past performance capabilities by documenting previous project experiences, which would be used to evaluate their qualifications for the current solicitation. The final section requires certification of the provided past performance information, including the preparer's signature, contact details, and date of submission.
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Text version
ATTACHMENT 2
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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