Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Solicitation number
- 140FS326Q0126
About this file
This is a Past Performance Survey form designed to collect information about a company's completed or in-progress contracts and subcontracts. The survey requests general business information including the company name, address, establishment date, key personnel (company president and vice president), and SAM.gov Unique Entity Identifier (UEI). It also captures the company's organizational structure by requesting identification of whether the entity is a partnership, separate entity, or division.
The form provides three detailed sections for documenting past contracts or subcontracts, whether with government agencies or other entities. For each contract, respondents must supply the contracting agency or company name, point of contact information, contract number, contract amount, project title and location, scope of work, the company's role (prime contractor, joint venture partner, or subcontractor), details of any subcontracted work and amounts, period of performance, scheduled and actual completion dates, and percentage of work completed. The survey also requests information on contract terminations, quality control and safety plans implemented, any quality control or safety problems encountered, and how those problems were resolved. The form includes certification requirements and signature blocks for the survey preparer, with space for name, phone, email, title, signature, and date of preparation.
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| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0126.pdf | ||
| B08_-_Minimum_Specifications_tandem_disk_22_feet.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 .