B08_Past_Performance_Survey.doc
DOC document 35 KB Posted
- Attached to
- WATER WELL DRILLING - PA Federal contract opportunity
- Solicitation number
- 140FC224R0005
About this file
This document is a past performance survey template for a contractor to provide details on up to three past or present contracts to the federal agency for evaluation as part of a solicitation for water well drilling services in Pennsylvania.
The survey requests information on the contractor's general business including organization date, leadership, and SAM registration. For each of the past contracts listed, the contractor is asked to provide the contracting agency or company as a reference, the point of contact and their phone number, the contract number, value, title, location and general scope of the project. Additionally, the contractor specifies its role as prime contractor, joint venture partner, or subcontractor and the work performed. The survey also collects subcontracting details and performance period, scheduled and actual completion dates, percentage of work completed, and whether quality control and safety plans were used and if any issues arose.
The related federal contract opportunity is solicitation number 140FC224R0005 from the Department of the Interior Fish and Wildlife Service for water well drilling services in Pennsylvania.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_140FC224R0005_Amd_0001.pdf | ||
| Q_A_0001.docx | DOCX document | |
| B08_Quote_Schedule.pdf | ||
| B08_Wages.pdf | ||
| B08_SOW.pdf | ||
| Sol_140FC224R0005.pdf |
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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 .