Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- GA-NWR LE DIV ZONE OFCR-BULLET TRAPS Z-8
- Solicitation number
- 140FS326Q0128
About this file
This is a Past Performance Survey template designed to collect documentation of a contractor's relevant experience on completed or in-progress contracts. The form requests general business information including company name, address, organization date, SAM.gov Unique Entity Identifier (UEI), and organizational structure (partnership, separate entity, or division).
The survey requires detailed information on up to three past or present contracts or subcontracts, with preference given to government contracts. For each contract entry, respondents must provide the contracting agency or company name, point of contact and telephone number, contract number, contract amount, project title and location, scope of work, the firm's role (prime, joint venture, or subcontractor), subcontract details and amounts, period of performance with scheduled and actual completion dates, percentage of work completed, termination status, quality control and safety plan implementation, and documentation of any quality control or safety problems encountered and their resolutions. The form also includes signature blocks for the survey preparer with contact information, title, and date certification of the past performance information provided.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0128_Amd_0002.pdf | ||
| B09_-_A0001_-_Questions_and_Answers_0002.docx | DOCX document | |
| Sol_140FS326Q0128_Amd_0001.pdf | ||
| SPECIFICATIONS_for_7.pdf | ||
| Sol_140FS326Q0128.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 .