Attachment_5__PAST_AND_PRESENT_PERFORMANCE_SURVEY.pdf
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- Solicitation number
- 140F0221R0018
About this file
This document includes an attachment for a past and present performance survey and details of a solicitation to construct a multipurpose facility at Bombay Hook National Wildlife Refuge in Delaware. The solicitation involves providing all labor, equipment, and materials to complete a parking area, visitor center, administrative offices, and associated site improvements and utility upgrades on a firm-fixed-price basis. Offerors must submit information on relevant past performance, bonding, personnel, and a price proposal in accordance with the instructions and evaluation criteria provided. A pre-proposal site visit is scheduled for July 29th and August 4th, 2021 at the project address. The solicitation was issued by the U.S. Fish and Wildlife Service Region 2 for the Department of the Interior.
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ATTACHMENT 5 140F0221R0018 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 140F0221R0018 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 140F0221R0018 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 140F0221R0018 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 |
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