Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- SC-CAROLINA SANDHILLS NWR ORCHARD SPEADER
- Solicitation number
- 140FS326Q0122
About this file
This is a Past Performance Survey form template used to collect historical contract performance information from prospective vendors responding to federal solicitations.
The survey captures general business information including company name, address, organizational structure, establishment date, and key personnel. It requires detailed documentation of up to three completed or in-progress contracts or subcontracts, whether with government agencies or private companies. For each contract entry, respondents must provide the contracting agency or company name, point of contact information, contract number, dollar amount, project title and location, scope of work, and the respondent's role (prime contractor, joint venture partner, or subcontractor). Additional required details include the period of performance, scheduled and actual completion dates, percentage of work completed, termination status, and whether quality control and safety plans were implemented. The form also requests documentation of any subcontracted work, associated subcontract amounts, and descriptions of quality control or safety problems encountered during performance along with their resolutions. The completed survey must be signed by an authorized preparer with supporting contact information, phone number, email address, and date, and includes a certification statement affirming the accuracy of the past performance information provided.
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| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0122.pdf | ||
| B08_-_Specifications_Sheet_3_Ton_Orchard_Spreader.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 .