Attachment_3_Past_Performance_Survey_1.docx
DOCX document 26 KB Posted
- Attached to
- DUMPSTER RENTAL GREAT SWAMP NWR NEW JERSEY
- Solicitation number
- 140FS325Q0050
About this file
This document is a Past Performance Survey form designed for potential contractors to provide detailed information about their previous contracts. The form requires companies to document three separate contracts, including details such as contracting agency, contract amount, project scope, performance role, subcontractor information, quality control and safety plans, and completion status. Contractors must provide comprehensive information including contract value, performance period, percentage of work completed, and any quality or safety issues encountered.
The form is specifically related to a Department of the Interior Fish and Wildlife Service solicitation (No. 140FS325Q0050) for dumpster rental services at the Great Swamp National Wildlife Refuge in New Jersey. The contract involves providing dumpsters for demolition debris disposal at three separate properties in Millington and Gillette, NJ. The dumpsters are needed to handle two types of materials: clean concrete with metal reinforcement and general demolition debris, with structures already tested and abated for hazardous materials. Contractors must complete the past performance survey to demonstrate their qualifications for this project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment_1_Statement_of_Work.pdf | ||
| Sol_140FS325Q0050.pdf | ||
| Attachment_2_Wage_Determination.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT 3 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:
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? _____
4. Certification of Past Performance Information:Type or Print Information
Name of Survey Preparer _______________________________
Phone:__________________________ E-Mail;___________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
File details come from the government source that posted it. Updated .