Attachment_3_Past_Performance_Survey.pdf
PDF 154 KB Posted
- Solicitation number
- 140FS325Q0148
About this file
This document is a Past or Present Performance Survey form (Attachment 3) for a federal contract opportunity, designed to capture detailed information about a company's previous contracts and performance history. The five-page form requires companies to provide comprehensive details about up to three contracts, including the contract agency, project scope, contract amount, performance period, role (prime, joint venture, or subcontractor), subcontracted work, percentage of work completed, and information about quality control and safety plans. The form also includes sections for general business information like company establishment date, small business status, and a certification section for the survey preparer to complete and sign.
The survey requests specific contract details such as point of contact, telephone number, contract number, project title and location, general project scope, and the company's specific role and work performed. For each contract, companies must indicate whether they were terminated, used quality control and safety plans, and describe any quality control or safety problems encountered and how they were resolved. The final page includes a certification section where the survey preparer must provide their name, contact information, title, signature, and date, validating the accuracy of the performance information submitted.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS325Q0148.pdf | ||
| Attachment_2_Wage_Determination.pdf | ||
| Attachment_1_SOW.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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