Attachment_3_Past_Performance_Survey.doc
DOC document 36 KB Posted
- Attached to
- Relocation SVS for Great Dismal Swamp Suffolk VA
- Solicitation number
- 140FS324Q0212
About this file
This document is an Attachment 3 - Past or Present Performance Survey, which is part of a federal contract opportunity for Relocation Services for a non-government tenant at the Great Dismal Swamp National Wildlife Refuge in Suffolk, Virginia.
The survey requests information on up to 3 prior contracts or subcontracts completed or in progress, including the contracting agency, contract number, contract/subcontract amount, project details, the company's role (prime, joint venture, or subcontractor), any subcontracted work, period of performance, completion status, and any quality control or safety issues encountered. The company is also asked to provide general business information such as their UEI number, whether they are a small business, and contact details for the survey preparer. This information is requested to demonstrate the company's past performance qualifications for the current opportunity.
The related federal contract opportunity is for relocation services as outlined in the attached Statement of Work (SOW). Interested contractors/vendors must submit an RFQ using the provided SF1449 form and completed Attachment 3 to the contracting point of contact via email.
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Text version
ATTACHMENT 3
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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