Attachment_3_Past_Performance_Survey.doc
DOC document 36 KB Posted
- Attached to
- Gas heater system for Welaka NFH FL
- Solicitation number
- 140FS325Q0100
About this file
The provided document is a Past Performance Survey form designed to collect detailed information about a company's previous contract work. The template requires contractors to provide comprehensive details about up to three contracts, including agency/company name, contract number, contract amount, project location, scope, role (prime, joint venture, or subcontractor), period of performance, completion status, and quality control/safety plan implementation. The form captures key information such as contact details, subcontractor involvement, percentage of work completed, and any termination or performance issues encountered.
The survey form is specifically structured to allow potential contractors to document their past performance across multiple contracts, with sections for general business information, contract details, and a certification of past performance. The form appears to be part of a procurement process that requires vendors to demonstrate their previous experience and capability, potentially for evaluating qualifications for a future contract opportunity such as the Gas Heater System for Welaka NFH FL solicitation (Solicitation Number: 140FS325Q0100) issued by the Department of the Interior Fish and Wildlife Service.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_1_SOW.pdf | ||
| Attachment_2_Wage_Determination.pdf | ||
| Sol_140FS325Q0100.pdf |
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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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