Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- TN-WEST TENNESSEE REFUGE-FOLDING DISK
- Solicitation number
- 140FS326Q0127
About this file
This is a Past Performance Survey template used to collect information about a contractor's relevant experience on government and commercial contracts. The form requests general business information including the company name, address, organizational structure, SAM.gov Unique Entity Identifier (UEI), and key personnel. The survey requires contractors to document up to three completed or in-progress contracts or subcontracts, with detailed information for each including the contracting agency or company name, point of contact, telephone number, contract number, contract value, project title and location, general scope of work, and the contractor's role (prime, joint venture, or subcontractor).
For each contract listed, the survey collects performance metrics such as the period of performance, scheduled and actual completion dates, percentage of work completed, and termination status. The form also requires contractors to describe any work subcontracted to others and the total dollar amount of subcontracts. Additionally, contractors must indicate whether they implemented quality control and safety plans, describe any quality control or safety problems encountered, and explain how those problems were resolved. The survey concludes with certification requirements and requests the name, title, phone number, email, and signature of the person preparing the survey. This template is associated with a Fish and Wildlife Service solicitation for West Tennessee Refuge folding disk equipment (Solicitation Number 140FS326Q0127).
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0127.pdf | ||
| B08_-_Disk_spec_sheet.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 .