B08_Past_Performance_Survey.doc

DOC document 35 KB Posted

Attached to
Custom Exhibit Cabinetry and Trail Sign Replacemen
Solicitation number
140FC224R0001
Issued by

About this file

This document is a past performance survey for a contractor to complete regarding previous relevant contracts and subcontracts. It requests information on the contractor's general business including organization date, leadership, and unique entity ID. The contractor is asked to provide details on up to three past or present contracts as prime contractor, joint venture, or subcontractor including contracting agency or company, point of contact, contract number, amount, title, location, scope of work, role, any subcontracted work, period of performance, scheduled and actual completion dates, percentage completed, use of quality control and safety plans, and resolution of any issues. The related federal contract opportunity is solicitation number 140FC224R0001 for custom exhibit cabinetry and trail sign replacement services through the Department of the Interior Fish and Wildlife Service.

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Text version

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:

4. 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 .