Attachment_3_Past_Performance_Survey.doc
DOC document 36 KB Posted
- Attached to
- Portable Restroom Services at Sabine NWR
- Solicitation number
- 140FS326Q0011
About this file
This document is a Past Performance Survey form designed to collect detailed information about a company's previous contract work. The survey requests comprehensive details about up to three contracts, including the contracting agency, contract number, contract amount, project title, role (prime, joint venture, or subcontractor), scope of work, performance period, completion status, and quality control/safety plan implementation. The form requires companies to provide contact information, business details such as establishment date, leadership, SAM UEI number, and small business status, with space to document potential contract terminations or performance issues.
The survey is directly related to a federal contract opportunity for Portable Restroom Services at Sabine National Wildlife Refuge (NWR) in Hackberry, Louisiana, issued by the Department of the Interior Fish and Wildlife Service. The solicitation number is 140FS326Q0011, and the services are to be provided at 3000 Holly Beach Highway. Companies completing this past performance survey are likely bidding on the portable restroom services contract, with the form serving as a mechanism to evaluate the respondent's previous contract performance and capability to execute the proposed work.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0011.pdf | ||
| Attachment_2_Wage_Determination.pdf | ||
| Attachment_1_SOW_Sabine_NWR_Portable_Restroom_Services.docx | DOCX document |
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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__________________________________________
File details come from the government source that posted it. Updated .