Attachment_3_Past_Performance_Survey.pdf
PDF 154 KB Posted
- Attached to
- DUMPSTER RENTAL MOOSEHORN NWR MAINE
- Solicitation number
- 140FS325Q0038
About this file
This is a Past Performance Survey template (Attachment 3) used to collect information about a contractor's previous work experience. The 5-page form requests detailed information about up to three completed or in-progress contracts, with a preference for government contracts though other contracts are acceptable.
The survey requests company information including business name, address, establishment date, leadership details, UEI number, and small business status. For each contract reference, contractors must provide: contracting agency details, point of contact, contract number, contract amount, project title/location, scope of work, role (prime/joint venture/subcontractor), subcontracted work details, period of performance, completion dates, percentage complete, termination status, quality control and safety plan usage, any problems encountered and their resolutions. The form concludes with a certification section requiring the survey preparer's contact information and signature.
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| File | Type | Posted |
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| Attachment_1_SOW_Dumpsters__Moosehorn_NWR_2024-25.docx | DOCX document | |
| Attachment_2_Wage_Determination.pdf | ||
| Sol_140FS325Q0038.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 |
File details come from the government source that posted it. Updated .