Attachment_3_Past_Performance_Survey.pdf
PDF 154 KB Posted
- Attached to
- JOHN HEINZ NWR HVAC Service Agreement
- Solicitation number
- 140FS325Q0143
About this file
This document is a Past or Present Performance Survey (Attachment 3) used to collect detailed information about a company's previous contract work. The form requires companies to provide comprehensive details about up to three contracts, including contracting agency, contract number, project title and location, contract amount, performance period, role (prime, joint venture, or subcontractor), work performed, subcontracted work, completion percentage, and quality/safety plan usage.
The survey captures critical performance information such as scheduled and actual completion dates, whether the company was terminated, and any quality control or safety problems encountered during contract execution. The final section requires the survey preparer to certify the information by providing their name, contact details, title, signature, and date. This form appears to be part of a larger procurement process that evaluates a company's past performance and capabilities for potential future contract opportunities.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_2_Wage_Determination.pdf | ||
| Attachment_1_SOW_Heinz_HVAC_Service_Agreement.pdf | ||
| Sol_140FS325Q0143.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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