Attch5_RelevantExperienceSurvey_4pp.docx
DOCX document 24 KB Posted
- Attached to
- TN-ERWIN NFH-T25R1-REHAB ASPHALT PAVEMENT
- Solicitation number
- 140FGA26Q0013
About this file
This is a Past or Present Relevant Experience Survey template used to document a contractor's experience with completed or in-progress contracts. The form requests general business information including company name, address, date established, company leadership, and SAM.gov Unique Entity ID. Respondents must indicate company structure (partnership, separate entity, or division) and provide detailed information on up to three relevant contracts or subcontracts, whether government or commercial.
For each contract listed, the survey requires comprehensive documentation including the contracting agency or company name, point of contact, telephone number, contract number, contract amount, project title and location, general scope, the respondent's role (prime, joint venture, or subcontractor), description of work performed and any subcontracted work, performance timeline, completion status, quality control and safety plan implementation, and any problems encountered with resolution methods. The form must be completed and signed by the survey preparer with their name, phone, email, title, signature, and date, and includes a certification statement regarding the accuracy of past performance information.
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Other files
| File | Type | Posted |
|---|---|---|
| Attch1_SOW_T25R1_2026-02-03_48pp.pdf | ||
| B08_140FGA26Q0013_TC_34pp.pdf | ||
| Attch3_SectionB_QuoteSchedule.docx | DOCX document | |
| Attch2_WD-DBA_TN20260147_260102_5pp.pdf | ||
| Sol_140FGA26Q0013.pdf | ||
| Attch4_T25R1_QuoteSchedule_2026-02-03_1p.xlsx | XLSX spreadsheet |
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Text version
PAST OR PRESENT RELEVANT EXPERIENCE
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 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:
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): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
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 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): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
Type or Print Information Name of Survey Preparer
Phone:_ E-Mail;_ Title Signature Date )4. Certification of Past Performance Information:
File details come from the government source that posted it. Updated .