Past_Performance_Survey.doc

DOC document 35 KB Posted

Attached to
Abatement Services - MA Federal contract opportunity
Solicitation number
140FC224R0028
Issued by
Department of the Interior Fish and Wildlife Service

About this file

This document is a Past Performance Survey that a company would complete to provide information about their prior contracting experience. The survey requests details on up to three completed or in-progress contracts, including the contracting agency or company, contract number, value, period of performance, the company's role (prime, joint venture, or subcontractor), any subcontracted work, whether quality control or safety plans were used, and whether the company encountered any quality control or safety problems. The survey also asks for general business information about the company, such as date established, leadership, and entity type. This Past Performance Survey is related to the federal contract opportunity for "Abatement Services - MA" solicited by 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 .