Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- SC-CAROLINA SANDHILLS NWR-TANKS/FUEL
- Solicitation number
- 140FS326Q0125
About this file
This is a Past Performance Survey template used to collect and evaluate contractor experience on relevant projects. The form requires submission of general business information including company name, address, date established, and key personnel, along with the company's SAM.gov Unique Entity Identifier (UEI) and organizational structure. Contractors must document a minimum of three completed or in-progress contracts or subcontracts, providing comprehensive details for each including the contracting agency or company name, point of contact, telephone number, contract number, and contract/subcontract amount.
For each contract listed, respondents must describe the project title and location, general scope of work, their company's specific role (prime contractor, joint venture partner, or subcontractor), and any work subcontracted to others with associated costs. The survey also requires documentation of the period of performance, scheduled versus actual completion dates, percentage of work completed, and confirmation of whether termination occurred. Additionally, contractors must indicate whether quality control and safety plans were implemented, describe any quality control or safety problems encountered during performance, and explain how those problems were resolved. The completed survey must be signed and dated by an authorized representative, including their name, title, phone number, and email address. This form does not specify response dates, pricing terms, or set-asides, as it is a standard evaluation instrument for the solicitation identified as 140FS326Q0125 for SC-Carolina Sandhills National Wildlife Refuge Tank/Fuel work under the Department of the Interior Fish and Wildlife Service.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0125.pdf | ||
| B03_-_Service_Contract_Act_WD_2015-4457.pdf | ||
| B08_-_SOW_-_Fuel_Tank_Replacement.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 .