Attch4_Past_Performance_Survey_5pp.doc
DOC document 42 KB Posted
- Attached to
- ME RACHEL CARSON NWR PARKING LOT PROJECT
- Solicitation number
- 140FGA25Q0054
About this file
This is a Past or Present Performance Survey form (Attachment 4) for solicitation 140FGA25Q0054 related to the Rachel Carson National Wildlife Refuge Brown Road Parking Lot Project. The form requires contractors to provide comprehensive information about their company including general business details such as date of establishment, company officers, SAM.gov Unique Entity ID, and organizational structure (partnership, separate entity, division).
The survey mandates detailed information on up to three contracts or subcontracts completed or in progress, with government contracts preferred. For each contract, contractors must provide contracting agency details, contact information, contract numbers and amounts, project titles and locations, scope of work, their role (prime contractor, joint venture, or subcontractor), subcontracting details, performance periods, completion dates, percentage completed, termination history, and quality control/safety plan usage. The form also requires disclosure of any quality control or safety problems encountered and their resolution methods. The completed survey must be certified with the preparer's name, phone number, email, title, signature, and date.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 140FGA25Q0054_Sections_B-M_TermsConditions_34pp.pdf | ||
| Sol_140FGA25Q0054.pdf | ||
| Attch1_SOW_BrownStreetParkingLotProject_Redacted_6pp.pdf | ||
| Attch2_WD-DBA_ME20240049_YorkCo_Hwy_250103_5pp.pdf | ||
| Attch3_BidSchedule_1p.docx | DOCX document |
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Text version
140FGA25Q0054
Attachment 4 Rachel Carson NWR
Brown Road Parking Lot Project
PAST OR 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:
SAM.gov Unique Entity ID:
Is company a ; Partnership [ ] Separate entity [ ] Division [ ] N/A [ ]
2. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS
Complete and submit the information requested on page 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 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:
Percentage of Work Completed:
Were You Terminated?
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?
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:
3. Certification of Past Performance Information:
Type or Print Information
Name of Survey Preparer _______________________________Phone_________________
E-Mail___________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
File details come from the government source that posted it. Updated .