Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- SC SANTEE NWR HERBICIDE APPLICATION Federal contract opportunity
- Solicitation number
- 140FS326Q0124
About this file
This is a Past Performance Survey template designed to collect historical contract performance information from contractors bidding on federal opportunities. The form requests general business information including company name, address, organization date, key personnel, and SAM.gov Unique Entity Identifier (UEI), along with documentation of the company's organizational structure (partnership, separate entity, or division).
The survey requires contractors to detail up to three completed or in-progress contracts or subcontracts, with preference given to government contracts but allowing for commercial contract history if government experience is unavailable. For each contract entry, respondents must provide the contracting agency or company name, point of contact, telephone number, contract number, contract amount, project title and location, scope of work, the contractor's role (prime, joint venture, or subcontractor), any subcontracted work and amounts, period of performance, scheduled and actual completion dates, percentage of work completed, termination status, quality control and safety plan implementation, and any problems encountered with their resolutions. The form requires certification by the survey preparer with name, title, phone, email, signature, and date. This template is used in conjunction with the SC Santee National Wildlife Refuge Herbicide Application solicitation (140FS326Q0124) issued by the Department of the Interior Fish and Wildlife Service, enabling the government to evaluate contractor qualifications and past performance capability.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B03_-_Service_Contract_Act_WD_2015-4457.pdf | ||
| Sol_140FS326Q0124.pdf | ||
| B08_-_SOW_-_herbicide_package.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 .