Past_Performance_Survey.doc
DOC document 35 KB Posted
- Attached to
- AR-FWS WHITE RIV NWR-AERIAL GUNNING
- Solicitation number
- 140FS325Q0113
About this file
The Past_Performance_Survey.doc is a comprehensive document designed to collect detailed past performance information from potential contractors. The survey requests extensive information about a company's prior contracts, including up to three contracts with specifics such as contracting agency, contract number, contract amount, project scope, role (prime/subcontractor), performance period, completion status, quality control and safety plans, and any problems encountered during contract execution.
The survey is specifically related to a Department of the Interior Fish and Wildlife Service solicitation (140FS325Q0113) for an aerial gunning project at White River National Wildlife Refuge. The document requires companies to provide their general business information, SAM.gov Unique Entity Identifier, company structure, and a certification of past performance information, with space to document details for three separate contracts. The form is intended to help the government evaluate a contractor's previous performance, capability, and reliability before awarding a new contract.
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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 .