Attachment_C_Past_Performance_Questionnaire.doc
DOC document 36 KB Posted
- Attached to
- AL-DEEP HORIZON NRDA-FENCING AND PLANTIN
- Solicitation number
- 140FNR24R0005
About this file
This document is a Past Performance Questionnaire for a federal contract opportunity. It requests general business information about the company, including organization details, contracts completed or in progress, and any quality control or safety issues encountered. The questionnaire covers three specific contracts, asking for details on the contracting agency, contract number, project description, the company's role, subcontracted work, period of performance, and any delivery, quality, or safety problems. The questionnaire is intended to provide past performance information to support a federal contract bid, as indicated by the related contract opportunity for DEEP HORIZON NRDA - FENCING AND PLANTING, solicitation number 140FNR24R0005, issued by the U.S. 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:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
c. Third Contract:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
4. Certification of Past and Present Performance Information:
Type or Print Information
Name of Survey Preparer _______________________________
Phone:_________________ Email:______________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
File details come from the government source that posted it. Updated .