Attachment_5_Past_Performance_Questionnaire_(5).docx
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- Attached to
- AL-DEEP HORIZON NRDA-PLANTING-FENCE INST
- Solicitation number
- 140FNR26Q0003
About this file
This is a Past Performance Questionnaire template used to evaluate the qualifications and experience of contractors bidding on federal opportunities. The form requires vendors to provide general business information including company organization date, leadership names, and Dun & Bradstreet number, along with GSA contract status and schedule availability. Contractors must complete detailed information on up to three contracts or subcontracts, whether government or commercial, documenting the contracting agency or company name, point of contact, contract number, contract amount, project title and delivery location, scope of work, the contractor's role as prime, joint venture partner, or subcontractor, and any subcontracted work performed. For each contract, vendors must disclose the performance period in days, scheduled and actual completion dates, termination status, and whether quality control and safety plans were implemented. The form also requires documentation of any delivery, quality control, or safety problems encountered and how they were resolved. The questionnaire must be certified and signed by the survey preparer with their name, title, phone number, email address, and date. This template is used as part of the evaluation criteria for the AL-Deep Horizon NRDA-Planting-Fence Installation solicitation (140FNR26Q0003) issued by the Department of the Interior Fish and Wildlife Service.
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Text version
PAST PERFORMANCE QUESTIONNAIRE
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. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS
Does company have GSA contract? Yes / No
If so GSA contract(s) number:_________________________________________________
Is product offered on schedule? Yes / No
Complete and submit the information requested on the next pages 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.
a. First Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | |
| Contract Number: | Contract/Subcontract Amount: $ | |
| Project/Product Title and Delivery 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/Delivery Days: days Scheduled Completion/Delivery Date:
Actual Completion/Delivery Date:____
Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________
| Delivery, Quality Control or Safety 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/Product Title and Delivery 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): $
Scheduled Completion/Delivery Date:
Actual Completion/Delivery Date:____
Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________
| Delivery, Quality Control or Safety Problems encountered (if any): | _____ | |
| How were the problems resolved? | _____ |
c. Third Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | |
| Contract Number: | Contract/Subcontract Amount: $ | |
| Project/Product Title and Delivery 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): $
Scheduled Completion/Delivery Date:
Actual Completion/Delivery Date:____
Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________
| Delivery, Quality Control or Safety Problems encountered (if any): | _____ | |
| How were the problems resolved? | _____ |
4. Certification of Past and Present Performance Information:Type or Print Information
Name of Survey Preparer _______________________________
Phone:_________________ Email:______________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
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