Past_Performance_Survey.doc
DOC document 35 KB Posted
- Attached to
- FL J N DING DARLING NWR GATE REPAIRS -5
- Solicitation number
- 140FS325Q0102
About this file
The document is a Past Performance Survey form designed to collect detailed information about a company's previous contract work. The survey seeks comprehensive data on up to three contracts, including contract type, agency, scope, performance role, subcontractor details, contract value, performance period, quality control and safety plans, and any encountered problems.
The survey is specifically related to a Department of the Interior Fish and Wildlife Service solicitation (Number: 140FS325Q0102) for "FL J N DING DARLING NWR GATE REPAIRS -5", requiring companies to provide a thorough documentation of their past performance history. The form enables potential contractors to demonstrate their capability and track record by detailing contract specifics, including their role (prime, joint venture, or subcontractor), total contract amount, performance dates, completion percentage, and any quality or safety management approaches used during previous projects.
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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 .