Attachment 5 PAST AND PRESENT PERFORMANCE SURVEY.pdf
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- Solicitation number
- 140F0520R0025
About this file
This document contains a past and present performance survey for contractors to complete regarding previous government contracts. The survey requests information on the contractor's general business details, bonding company, and up to two previously completed or ongoing prime contracts and subcontracts. For each contract, details are requested on the contracting agency or company, point of contact, contract number, value, title and location, general scope of work, the contractor's role, any subcontracted work and values, period of performance, scheduled and actual completion dates, percentage completed, terminations, liquidated damages, use of quality control and safety plans, and resolution of any issues encountered. At the end, the survey is to be certified by name, title, signature and date of the preparer.
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ATTACHMENT 5 140F0520R0025 page 1 of 4
PAST AND PRESENT PERFORMANCE SURVEY
Your Company Name:
Street Address:
City, State and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
Company President: Vice President:
Dun & Bradstreet Number: __
Is company a ; Partnership [ ] Separate entity [ ] Division [ ] N/A [ ]
2. CONTRACT BONDING INFORMATION
Name of your bonding company intended to use:
Mailing Address:
City, State (including ZIP Code):
Point of Contact: Telephone No.: ( )
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.
ATTACHMENT 5 140F0520R0025 page 2 of 4
a. First Contract:
Contracting Agency or Company:
Point of Contact: Telephone Number:
Contract Number: Contract/Subcontract Amount: $
Project Title and Location:
General Scope of Construction 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?
Were You Assessed Liquidated Damages?
(If the answer to either Question is “Yes”, Explain:
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 5 140F0520R0025 page 3 of 4
b. Second Contract:
Contracting Agency or Company:
Point of Contact: Telephone Number:
Contract Number: Contract/Subcontract Amount: $
Project Title and Location:
General Scope of Construction 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?
Were You Assessed Liquidated Damages?
(If the answer to either Question is “Yes”, Explain:
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 5 140F0520R0025 page 4 of 4
4. Certification of Past and Present Performance Information:
Type or Print Information
Name of Survey Preparer_______________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
| PAST AND PRESENT PERFORMANCE SURVEY |
| 1. GENERAL BUSINESS INFORMATION |
| 2. CONTRACT BONDING INFORMATION |
| 3. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS |
File details come from the government source that posted it. Updated .