Past_Performance_Survey.doc
DOC document 35 KB Posted
- Attached to
- CT-SBM NWR-KIOSK PANEL PROJECT
- Solicitation number
- 140FS325Q0044
About this file
This is a Past Performance Survey template form requesting information about previous contracts completed or in progress by potential contractors. The 5-page form requires detailed information about the company including business structure, key personnel, and SAM.gov UEI number, followed by sections to document three previous contracts.
For each contract, respondents must provide details including contracting agency, point of contact, contract number, dollar amount, project scope, role (prime/subcontractor/joint venture), subcontracting details, period of performance, completion dates, quality control and safety plans, and any problems encountered and their resolution. The form concludes with a certification section requiring the preparer's contact information and signature. This template appears to be associated with solicitation 140FS325Q0044 for a kiosk panel project at CT-SBM NWR for the Department of Interior Fish and Wildlife Service, though the specific requirements of that project are not detailed in this document.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| B08_-_SOW.pdf | ||
| Sol_140FS325Q0044.pdf | ||
| B03_-_Service_Contract_Act_WD_2015-4125.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 .