Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- PA ERIE NWR FUEL TANK REPLACEMENT
- Solicitation number
- 140FS326Q0119
About this file
This is a Past Performance Survey template designed to collect historical contract performance information from potential federal contractors. The form requires companies to provide general business information including company name, address, date established, SAM.gov Unique Entity Identifier (UEI), and organizational structure (partnership, separate entity, or division). Companies must complete sections documenting up to three previously completed or in-progress contracts or subcontracts, with preference given to government contracts but allowing submission of commercial contracts if government experience is unavailable.
For each contract entry, respondents must supply detailed information including the contracting agency or company name, point of contact and telephone number, contract number, contract/subcontract amount, project title and location, general scope of work, the company's role (prime contractor, joint venture partner, or subcontractor), description of any subcontracted work with total subcontract amounts, period of performance with scheduled and actual completion dates, percentage of work completed, termination status, quality control and safety plan implementation, and any quality control or safety problems encountered with their resolution. The survey requires certification by the preparer with signature, title, phone number, email, and date. This template is associated with solicitation 140FS326Q0119 for PA Erie National Wildlife Refuge Fuel Tank Replacement, issued by the Department of the Interior Fish and Wildlife Service.
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| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0119.pdf | ||
| B08_-_SOW___Specs.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 .