B08_Attachment_03_Tech_Past_and_Present_Performance_Questionnaire.docx
DOCX document 24 KB Posted
- Solicitation number
- 140F0121R0105
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TECHNICAL/PAST AND PRESENT PERFORMANCE QUESTIONNAIRE
Your Company Name:
Street Address:
Email Address:_____________________________________ City, State and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
| Company President: | Vice President: | |
| Dun & Bradstreet Number: | __ |
Is company; Sole Propriety [ ] Partnership [ ] Corporation [ ] Division [ ] N/A [ ]
2. FINANCIAL INFORMATION
a. Name of your bank:
Mailing Address:
City, State (including ZIP Code):
Point of Contact: Telephone No.: ( )
b. Estimating is performed by a separate department [ ], accounting department [ ], contract department [ ]; or OTHER. If “OTHER”, explain:
3. 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 Design Build Project:
Your Role (General Contractor [ ], Joint Venture [ ], Designer [ ], 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? _____
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 (General Contractor [ ], Joint Venture [ ], Designer [ ], 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? _____
c. Third 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 (General Contractor [ ], Joint Venture [ ], Designer [ ], 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? _____
4. Certification of Past and Present Performance Information:Type or Print Information
Name of Survey Preparer_______________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
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