Attachment_4-_Past_Performance_Survey.doc
DOC document 37 KB Posted
- Attached to
- Clay and Soil Materials, Blackwater NWR, MD
- Solicitation number
- 140FS323Q0146
About this file
This document contains a past performance survey template for federal contractors and a solicitation notice for clay and soil materials for the Blackwater National Wildlife Refuge in Maryland. The past performance survey collects general business information and details on up to two previously completed or ongoing government contracts, including contracting agency, point of contact, contract number, value, scope of work, period of performance, completion dates, quality control approach, and problems encountered. Respondents must certify the accuracy of the information provided. The related solicitation seeks clay and soil materials for the Blackwater NWR, with responses due by January 14, 2023. The Department of the Interior Fish and Wildlife Service is the issuing agency.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_2-_Delivery_location.pdf | ||
| Attachment_1-_Supply_Requirement.pdf | ||
| Attachment_3-_Quote_Schedule.docx | DOCX document | |
| Sol_140FS323Q0146.pdf |
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Text version
ATTACHMENT 2
GSA RFQ page 4 of 4
GSA CONTRACTOR---PAST PERFORMANCE SURVEY
Your Company Name:
Street Address:
City, State and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
Company President:
Vice President:
UEI:
Is company a ; Sole Propriety [ ] Partnership [ ] Corporation [ ] Division [ ] N/A [ ]
2. GSA INFORMATION
A. GSA Contract Number:
Order Limits? Minimum
Maximum
B. Do you have a servicing office in the service/delivery location? Yes___ No ____
If yes;
Address: _______________________________________
Local POC Name: _________________________
Local POC Phone: ________________________
3. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS
Complete and submit the information requested on page 2-3 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.
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:
Were You Terminated?
Did you use a Quality Control Plan? _________ Quality Control Problems encountered (if any):
How were the problems resolved?
b. Second 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:
Were You Terminated?
Did you use a Quality Control Plan? _________ Quality Control Problems encountered (if any):
How were the problems resolved?
4. Certification of Past Performance Information:
Type or Print Information
Name of Survey Preparer_______________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
File details come from the government source that posted it. Updated .