Attachment_3_Past_Performance_Questionnaire.doc
DOC document 36 KB Posted
- Attached to
- AL-DH NRDAR-AERIAL IMAGES NESTING ACT
- Solicitation number
- 140FNR24R0002
About this file
This document is a past performance questionnaire for federal contractors. It requests information on up to three previous government or commercial contracts completed or in progress, including contracting agency, point of contact, contract number, value, period of performance, scheduled and actual completion dates, role as prime contractor or subcontractor, work performed, any subcontracting, use of quality control and safety plans, and issues encountered. The related federal contract opportunity is solicitation number 140FNR24R0002 for AL-DH NRDAR-Aerial Images Nesting Act from the Department of the Interior Fish and Wildlife Service, but no additional details are provided. The past performance questionnaire seeks relevant contract references but does not specify any products or services required, pricing terms, response dates, or other salient information regarding an active procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FNR24R0002.pdf | ||
| B08_Solic_140FNR24R0002.doc | DOC document | |
| A05_PWS_NBI_HighResolutionImages.docx | DOCX document |
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Text version
PAST PERFORMANCE QUESTIONNAIRE
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. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS
Does company have GSA contract? Yes / No
If so GSA contract(s) number:_________________________________________________
Is product offered on schedule? Yes / No Complete and submit the information requested on the next pages 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/Product Title and Delivery 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/Delivery Days: days Scheduled Completion/Delivery Date:
Actual Completion/Delivery Date:____
Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Delivery, 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 and Present Performance Information:
Type or Print Information
Name of Survey Preparer _______________________________
Phone:_________________ Email:______________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
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