Attachment_3_Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- Trash and Recycling at John Heinz NWR PA
- Solicitation number
- 140FS326Q0061
About this file
This is a Past or Present Performance Survey template designed to collect and document contractor performance history for federal contracting purposes.
The form requires companies to provide general business information including company name, address, establishment date, principal officers, SAM.GOV UEI number, and small business status. The primary focus is Section 2, which requests detailed information on up to three completed or in-progress contracts or subcontracts. For each contract, respondents must document the contracting agency or company, point of contact with telephone number, contract number, contract amount, project title and location, general scope of work, and the contractor's role (prime, joint venture, or subcontractor). Additional required details include the value and description of any subcontracted work, period of performance in days, scheduled and actual completion dates, percentage of work completed, termination status, and implementation of quality control and safety plans. Respondents must describe any quality control or safety problems encountered and explain how they were resolved. Section 4 requires certification by the survey preparer, including name, phone number, email address, title, signature, and date. Government contracts are preferred, but non-government contracts may be submitted if government contract experience is unavailable. This template serves as a standardized mechanism for evaluating contractor past performance capabilities and compliance history.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_1_SOW_Heinz_Weekly_Trash___Recycling_Services.pdf | ||
| Sol_140FS326Q0061.pdf | ||
| Attachment_2_Wage_Determination.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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