Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- TN-TN NWR-GRAVEL
- Solicitation number
- 140FS326Q0099
About this file
This is a Past Performance Survey template designed to collect information about a company's relevant contract experience for evaluation purposes in federal solicitations. The survey gathers comprehensive business information including company organization details, SAM.gov Unique Entity Identifier (UEI), and the company's organizational structure (partnership, separate entity, or division).
The form requests detailed information on up to three completed or in-progress contracts or subcontracts, with preference for government contracts but allowance for other relevant commercial work. For each contract, respondents must provide the contracting agency or company name, point of contact information, contract number, contract amount, project title and location, general scope of work, the company's role (prime contractor, joint venture partner, or subcontractor), subcontracted work details with amounts, period of performance, scheduled and actual completion dates, and percentage of work completed. The survey also requires documentation of quality control and safety plan implementation, any quality control or safety problems encountered, and how those problems were resolved, along with termination status. The form includes certification language and requires signature, date, preparer name, phone number, email, and title. This template is used to assess contractor capability and past performance for the TN-TN NWR-GRAVEL solicitation (140FS326Q0099) issued by the Department of the Interior Fish and Wildlife Service.
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Other files
| File | Type | Posted |
|---|---|---|
| B08_-_Gravel_SOW_Tennessee_NWR.pdf | ||
| Sol_140FS326Q0099.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:
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): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
c. Third 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): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
Type or Print Information Name of Survey Preparer
Phone:_________________ E-Mail;___________________________ Title Signature Date )4. Certification of Past Performance Information:
File details come from the government source that posted it. Updated .