Past_Performance_Survey.doc
DOC document 35 KB Posted
- Attached to
- Well Rehabilitation - VA Federal contract opportunity
- Solicitation number
- 140FC224R0027
About this file
This document is a Past Performance Survey form to be completed by a company bidding on a federal contract opportunity. The form requests general business information about the company, including the organization's date of establishment, leadership, and Unique Entity ID. It also asks the company to provide details on up to three past or current contracts, including the contracting agency, project scope, the company's role, the contract/subcontract amount, period of performance, and whether any quality control or safety issues were encountered. The company must certify the accuracy of the information provided.
The related federal contract opportunity is for "Well Rehabilitation - VA" issued by the Department of the Interior Fish and Wildlife Service. The solicitation number is 140FC224R0027.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B08_Quote_Shedule.docx | DOCX document | |
| B08_SOW_Photos.pdf | ||
| B03_Wages.pdf | ||
| Sol_140FC224R0027.pdf | ||
| B08_SOW.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 .