Attachment_3_Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- Demolition dumpster services at Umbagog NWR NH
- Solicitation number
- 140FS326Q0063
About this file
This is a Past or Present Performance Survey form designed to collect information about a contractor's relevant contract history and experience.
The survey requires companies to provide general business information including company name, address, establishment date, company president and vice president names, UEI number from SAM.GOV, and small business status. The primary focus is documenting completed or in-progress contracts (government contracts are preferred, though other contracts may be submitted if government experience is unavailable). Companies must submit detailed information on up to three contracts or subcontracts, including the contracting agency or company name, point of contact with telephone number, contract number, contract amount, project title and location, general scope of work, the company's role (prime, joint venture, or subcontractor), description of any subcontracted work and amounts, period of performance in days, scheduled and actual completion dates, percentage of work completed, termination status, and quality control and safety plan implementation. Additionally, companies must report any quality control or safety problems encountered and describe how they were resolved. The form concludes with a certification section requiring the survey preparer's name, phone number, email address, title, signature, and date. This template appears in a five-page document and serves as a standardized tool for evaluating contractor past performance capabilities.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0063.pdf | ||
| Attachment_1_Umbagog_Demolition_Dumpsters_SOW.pdf | ||
| Attachment_2_Wage_Determination.pdf | ||
| Attachment_4_Bid_Schedule.pdf |
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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.
http://www.sam.gov/
ATTACHMENT 3 page 2 of 5
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?
ATTACHMENT 3 page 3 of 5
b. Second Contract:
Point of Contact: Telephone Number:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: %
ATTACHMENT 3 page 4 of 5
c. Third Contract:
Point of Contact: Telephone Number:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: %
ATTACHMENT 3 page 5 of 5
4. Certification of Past Performance Information:
Type or Print Information
Name of Survey Preparer _______________________________
Phone:__________________________ E-Mail;___________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
| PAST OR PRESENT PERFORMANCE SURVEY |
| 1. GENERAL BUSINESS INFORMATION |
| 2. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS |
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