Past_Performance_Survey.doc
DOC document 35 KB Posted
- Attached to
- MD-PATUXENT RES REF-WASTE WATER PUMPING Federal contract opportunity
- Solicitation number
- 140FS324Q0177
About this file
This document is a Past Performance Survey that requests information from a company about their completed or ongoing contracts. The survey asks for general business information, details on up to three contracts or subcontracts, and certification of the information provided. The requested details include the contracting agency, contract number, amount, scope, the company's role, subcontracted work, performance timelines, quality control and safety plans, and any problems encountered.
The survey is related to a federal contract opportunity from the Department of the Interior Fish and Wildlife Service for "MD-PATUXENT RES REF-WASTE WATER PUMPING". The solicitation number is 140FS324Q0177. The survey appears to be part of the process for evaluating past performance as part of the contract opportunity.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B08_-_SOW_septic_pumping.pdf | ||
| B03_-_Wage_Determination_2015-4281.pdf | ||
| Sol_140FS324Q0177.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 Identifier (UEI):
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 .